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InSight 30-Day Trial Membership Application Form

Trial memberships are limited to one 30-day period for each person. This trial membership will allow access to the InSight Members Only section of the Web site only. Eligibility to attend the annual conference or enhancement voting is not included.
 
PART I: GENERAL INFORMATION
* = Field Required
*First Name
MI
*Last Name
Nickname
Department
Title
EMail Address
I do not have Email. I do have Internet access. I do not have Internet access.
Business Address (Required)

*Street
*City
*State/Province
*Zip/Postal Code
Home Address (Optional)

Street
City
State/Province
Zip/Postal Code
Check here if your home address is your preferred mailing address.
Telephone
Fax
Former User Group
# Of Years
PART II: TYPE OF MEMBERSHIP YOU ARE APPLYING FOR - INDIVIDUAL TRIAL MEMBERSHIP
Eligibility: Every individual member must be an employee of a license holder of one or more products of McKesson Information Solutions. 

*Hospital/Healthcare System

*McKesson Customer Number
*Select Membership Type
Free 30 Day Individual Trial Membership
           (I am an employee of this Hospital/Healthcare System)
Free 30 Day Contracted Employee Membership
           (I am a full-time contracted employee of this Hospital/Healthcare System)
Free 30 Day Contracted Consultant Membership
           (I am a full-time contracted consultant for this Hospital/Healthcare System)
           **Direct Supervisor Name
           		**Direct Supervisor Phone
**Supervisor Information is required if and only if you are a Contracted Consultant

- OR -

Click Here for a 30 Day Trial Membership Form in Adobe Acrobat (.pdf) format for mailing or faxing.


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