SNAIL Organizational Code Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Organization *Your Name *FirstLastEmail to send the results to *What type of organization are you purchasing a code for? *CorporationNonprofitAcademic Institution(Corporations) How many individuals will be using the code?Please choose an option from this dropdown list.1 - 50 - $125.0051 - 200 - $250.00201 - 500 - $500.00501 - 1000 - $1,000.001001+ - $2,500.00(Nonprofits) How many individuals will be using the code?Please choose an option from this dropdown list.1 - 50 - $75.0051 - 200 - $150.00201 - 500 - $300.00501 - 1000 - $600.001001+ - $1,500.00(Academic Institutions) How many individuals will be using the code?Please choose an option from this dropdown list.1 - 50 - $75.0051 - 200 - $150.00201 - 500 - $300.00501 - 1000 - $600.001001+ - $1,500.00Payment Information *You will receive results twice by the dates you select. Please select your first date below. *Please select the second date you want to receive results by below. *I acknowledge that my purchase means I will receive results twice on the dates I selected above, and that entries after the last date or above the maximum number of individuals I purchased a code for will be excluded.YesNoSubmit Stay Up to Date Imagine what Responsible AI will do for healthcare. Donate Today Join Our Bi-Weekly NewsletterPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Subscribe Follow Us Follow
