Register for a PROSTIVA RF Therapy seminar

First name:*

Last name:*

Street address:*

Street address:

City:*

State/Province:*

ZIP/Postal code:*

E-mail:*

Phone:*

Which seminar would you like to attend?*

	Seminar:	Dr. Ian Goldman
	Date:	Tuesday, January 22, 2008 6:00 PM MST
	Location:	Pinnacle Surgery Center 6790 W. Thunderbird Road Peoria, AZ 85381 623-979-1717

	Seminar:	Dr. David Cahn
	Date:	Tuesday, January 29, 2008 5:30 PM MST
	Location:	Sheraton Denver West Hotel 360 Union Blvd Lakewood, CO 80228 303-987-2000

	Seminar:	Dr. Sourjya Misra
	Date:	Wednesday, January 30, 2008 5:00 PM PST
	Location:	Eden Medical Center, Conference Room A 20103 Lake Chabot Road Castro Valley, CA 94578 510-537-1234

	Seminar:	Dr. Wayne Glazier & Dr. BG Parulkar
	Date:	Tuesday, February 26, 2008 6:00 PM EST
	Location:	85 Prescott Street, Suite 304 Worcester, MA 01605

Will a guest attend the seminar with you?

Please provide first and last name of your guest:

First name:

Last name:

Have you been diagnosed with symptomatic enlarged prostate, also known as benign prostatic hyperplasia (BPH)?

Are you considering the PROSTIVA RF Therapy procedure? *

Where did you hear about PROSTIVA RF Therapy?

Friend
Family
Doctor
Urologist
Television
Radio
Newspaper
Magazine
Poster
Seminar/Event
Other

Would you like to receive a packet of information about PROSTIVA RF Therapy?*

The packet includes a free video in DVD format. Would you like the video in VHS (video tape) format instead?*

You will receive the information in about 5 business days. You may also visit www.TakeControlOfYourFlow.com for information sooner. Thank you for registering for this educational seminar.

By completing and submitting this form, you are granting Medtronic permission to add your contact information to its database for PROSTIVA RF Therapy and consent to receiving future materials about Medtronic's products and services.

Important: Medtronic respects the confidentiality of personal information. We assure you that we will not share your responses or personal information, except as otherwise noted in our Privacy Policy.

To remove your name from Medtronic's PROSTIVA RF Therapy mailing list at any time, e-mail or send a request in writing to:

Medtronic Inc.
PROSTIVA RF Therapy
710 Medtronic Parkway, X-184
Minneapolis, MN 55432

PROSTIVA^® RF Therapy

For symptomatic enlarged prostate (BPH)