Ultrasound Training - Register for a Course

Axess Ultrasound Training Course Enrollment Form

Note: items marked with * are required.

Course

*Course:

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

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, contact Becky VanNieuwenhze at 317-275-5577 at least 24 hours in advance.