Ultrasound Training - Register for a Course

Axess Ultrasound Training Course Enrollment Form

Note: items marked with * are required.

Course

*Course type:

Basic Information

*First Name:

*Last Name:

*Facility:

Contact Information

*Address:

*City:

*State:

*Zip/Postal Code:

*Country:

How to Contact You? Phone Email

*Email:

*Phone:

Fax:

Verification

Verification Information

Type the numbers you see in this picture. This ensures that a person, not an automated program, is filling out the form.

*Numbers:

Please note: Attendees are expected to make their own travel arrangements to Indianapolis and arrange for their hotel.

If you require transportation to the Axess Ultrasound facility, or have any other questions contact Becky VanNieuwenhze at 317-275-5577 at least 24 hours in advance.

Ultrasound Training - Register for a Course

Axess Ultrasound Training Course Enrollment Form

Verification Information

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