SwiftMR™ Limited Evaluation Registration Form

This Limited Evaluation Registration Form, upon completion, constitutes a legally binding agreement for the limited use of the AIRS Evaluation Product (as defined below) provided by AIRS Medical Inc. (“AIRS”) to the customer identified below (“Customer”).

 

The purpose of this Limited Evaluation Agreement is to provide Customer with access to the AIRS Evaluation Product for the length of time reasonably necessary under the circumstances to assess its appropriate use and functionality. While the license to the AIRS Evaluation Product is provided at no cost during the evaluation period, certain implementation activities necessary to facilitate this evaluation may incur fees. These fees will be clearly communicated to the Customer in advance.

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Your Name
Which MRI scanners do you have? (Select all that apply)
How did you come to know us?
Master Service Agreement
Business Associate Agreement
Marketing Agreement
Privacy Statement Agreement
Consent for Collection and Use of Personal Information (Required)
Consent for Collection and Use of Personal Information (Required)



For the purpose of “Request Free Trial” service, we collect and use the following personal information:

- Purpose of processing: responding to the request, providing free trial of the product and the service, managing the history of free trial

- Items processed: Name, Email, Phone number, Institution/Company name, Position

- Retention period: Unless there is an obligation to preserve under relevant laws, up to 3 years from the date of submission



You have the right to refuse consent. However, refusal to consent to required items may result in restricted service.