Information Request and Feedback Form

Please fill in the form below and click 'Submit Form' to request information or a SafeSpecs password, express an interest in our courses or to feedback your opinions to KCARE.

Please enter your name:
Please enter the name and address of your company/institution:
Please enter your e-mail address:
Please enter your telephone number:
Please enter your occupation:
Would you like a Safespecs password?:	Yes No
How did you hear about SafeSpecs?
Have you been issued with a SafeSpecs password before?	Yes No
Please enter your request for information or give us your feedback. It would be useful if you could tell us which X-ray imaging equipment you are considering (eg general room / digital / fluoroscopy etc):

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