3M™ Littmann® Students Program - Register Your Stethoscope

First Name*

Last Name*

What is your profession?*-- Please Select --MedicineNursingRespiratoryVeterinaryOther (please specify)

If other, please specify

Year of Education:*-- Please Select --1st Year Undergraduate2nd Year Undergraduate3rd Year Undergraduate4th Year UndergraduateMaster of Science (MSc)Doctoral (PhD) degreeResidentOther (please specify)

If other, please specify

Please enter your specialisation:

Student ID*

University/College*

City*

Province*-- Please Select --AlbertaManitobaBritish ColumbiaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Student's Telephone Number*

Email*Student's email

How did you hear about the Students Program?*-- Please Select --FacebookSchool Presentation3M™ Littmann® Stethoscopes websiteOther

If other, please specify

Location of Presentation*

Distributor's name

Presenter's name (if available)

Distributor Name*

Sales Representative Name (if applicable)

Distributor City*

Distributor Province*-- Please Select --AlbertaManitobaBritish ColumbiaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

If online: (Please specify the site)

Purchase Date (YY/MM/DD)*

Invoice Number*

Select a Model*-- Please Select --3M™ Littmann® Cardiology IV Regular Warranty 7 years/ Extended Warranty 10 years3M™ Littmann® Master Cardiology™ | Regular Warranty 7 years | Extended Warranty 10 years3M™ Littmann® Classic III | Regular Warranty 5 years | Extended Warranty: 6 yearsRefer to the outer box

Littmann Catalogue Number*Refer to the outer box

Serial Number*Refer to the stethoscope chest piece

Price ($CAD) before tax

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