Internet Dermatology Society Sponsors

Please fill in the below information if you would like to be a sponsor of the 2010 meeting.

First Name:

Last Name:

Title:

Institution:

Address:

Address line 2:

City:

State:

Country:

Zip:

Phone:

Fax:

Email:

What are your specific areas of clinical interest?

Comments?

I am a member of the Internet Dermatology Society.

I would like to receive informative email about the Internet Dermatology Society and related topics.

I am unable to attend the meeting on March 4th, 2010, but I would like to receive a summation of the meeting's content.

If you have trouble submitting please contact mdolan@thousandwordpictures.com.