form-video

Video upload form

Participant Information

First name

Last name

Email

Phone

Address information

Company

Address

Postal Code

City

Country

Message

Message

Labeling: The videos must be labelled in the file name with contestant’s last name and name followed by submission number of the image, example: DoeJohn1

Video 1

First name/last name

Disease/Diagnosis

Device used

Video

Add additional video?
All fields are mandatory. Please complete all fields otherwise your entry will not be considered.

Video 2

First name/last name

Disease/Diagnosis

Device used

Video

Accept Participation terms

Accept Privacy Policy

Please confirm that you have read & understood the Participation terms & Privacy Policy by checking the boxes above. Both boxes must be checked to submit your entry.