WWW Health Awards

Contact Information:

Name:

Title:

Company:

Address:

City:

State:

ZIP Code:

Country:

Phone:

Fax:

E-Mail:

Are you fluent in any language other than english? Please list below.

Note: Any specialties you check will help us assign entries that are focused in your area of expertise. If none are checked, you will be given a general variety of entries.

Health Specialties:
(CHECK ALL THAT APPLY)

Consulting

Education

Food Industry

Government

HMO/Managed Care

Home Health Care

Hospital/Health Care

Insurance

Media/Publishing

Medical Communications

Medical Equipment/Supplies

Nonprofit

Nurse/Allied Health Professional

Pharmaceutical

Physician

Religious Organization

Web Specialties:
(CHECK ALL THAT APPLY)

Web Design	Graphic Design	E-Commerce

I am Interested in Judging:

Spring/Summer, 2008

Fall/Winter, 2008