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PASSWORD*	CONFIRM PASSWORD*

IDENTITY VERIFICATION QUESTION *	IDENTITY VERIFICATION ANSWER*

CUSTOMER NUMBER*
	Your Customer Number is your ImmucorGamma account number that you use to place orders. It can be found in your invoices or by contacting our Customer Service Department at 800.510.5110.

FIRST NAME*	MI	LAST NAME*

EMAIL ADDRESS*	CONFIRM EMAIL ADDRESS*

Immucor has created a new system for electronic communication of product recalls and technical communications. By indicating your acceptance below, you will receive timely email notifications linking you directly to these important communications.

Yes, I want to receive notifications of product RECALL NOTIFICATIONS and TECHNICAL COMMUNICATIONS.

Company Information

COMPANY NAME*	YOUR TITLE*

COMPANY ADDRESS 1*	COMPANY ADDRESS 2

COMPANY CITY*	COMPANY COUNTRY*

COMPANY STATE/PROVINCE	COMPANY ZIP/POSTAL CODE*

COMPANY PHONE*

I want to be a member of these groups

Capture	Galileo	Galileo Echo
International Distributors	NEO	Reagents

Other Information

1. LIS System	5. Antibody Screening Method
2. Check if you perform donor testing	6. Antibody Identification Method
3. Check if you perform patient testing	7. Daily Screen Volume
4. Daily Type

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