Join the Advita Surgeon Locator

I hereby authorize Advita, Inc. to publish my name and contact information, whether through electronic or written media, including but not limited to publication on the Advita website and/or Advita sales and marketing literature. I understand and agree that my name is being used in connection with a surgeon locator program, for the purpose of identifying the Advita products that I use in my surgical practice. I also understand that I will not be paid a fee by Advita for participating in the surgeon locator program, nor will Advita provide referrals of any kind to me or my practice in relation to the use of their products. The surgeon locator is intended as a general information tool only, and not as an endorsement or certification of my skills, training or qualifications. I may ask to have my name removed from any media in which it is published by Advita at any time.