Medamation MD Registration

This form is for those who have purchased Medamation MD and need a User Code to enable their software to create an unlimited number of records. 

Medamation MD Registration
Salutation:
End User's First Name:
End User's Last Name:
Address:
City:
State:      Zip:
Email Address:
Please Type Email Again :
Company/Hospital Name:
Number of Care-Provider Licenses: 
Number of Data-Entry Licenses: 
Serial Number: Click Here to locate
Vendor Code: Click Here to find
Reseller's Name:
 How would you like the User Code sent to you?    Mail    Email   Phone
Additional Comments:

Upon receipt of registration form & payment, Medamation Inc. will generate and send you a unique User Code.  Copy and paste the User Code into Medamation MD's registration screen to enable unlimited charts.

 

 Copyright 2006 Medamation Incorporated