The Dictation Source - Register for Dictation Services

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	TESTIMONIALS:

To assist us in getting you started rapidly, please fill out the form below with your information and click the Register button. You will receive your login information via email within 24 hours.

Make sure that all the mandatory fields are filled before clicking the Register button. Please wait untill you receive confirmation of your registration before signing off.

If you need personal assistance, don't hesitate to call 877 768 1079.

Thank you for taking the time to register.

* = Mandatory Fields

Please fill in all mandatory fields

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*First Name:     
Middle Initial:  
*Last Name:      
*Street:         
*City:           
*State / Zip:     

                 (This field is used for billing purposes)
Affiliation:     

*Specialty:      
Co-specialty:    

*Email Address:  
                 Would you like to receive work confirmation
                 notice via this Email Address?
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Alternate Email: 
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                 notice via this Email Address?
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Please specify your full phone number including area code
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Word Processor:  In what format should the dictations be
                 sent to you?
                 Microsoft Word 97 and up
                 Word Perfect 7 and up
                 ASCII Text