Shared Imaging Services Registration PageFirst name *Last name *Hospital *Please enter the name of your HospitalUser Name *User NamePassword *PasswordEmail *EmailMembership Level HospitalInstructions Note that after you hit the submit button below if there are any errors to correct on your form you will be asked to correct them. If your form is complete and you hit the Submit buttton, it will take several minutes to process. After acceptance of your registration info you will be redirected to a Thank you page with further information on the registration process. Verification Please enter any two digits with no spaces (Example: 12)* This box is for spam protection - please leave it blank: