Ultrasound Education Course Registration - Canada

Thank you for registering for your upcoming ultrasound clinical education course with Philips Healthcare. In order for your registration to be processed without delay, it is imperative that you complete all information on this form. Incomplete forms will impede your registration and may prevent you from receiving your desired training date and location. You can view a copy of our travel policy here.

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PERSONAL INFORMATION

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Salutation	Professor Doctor Mr. Mrs. Ms
* First Name
*Last Name
Position/Title
*Company/Institution
*Address
*City
*State
*Post/Zip
*Country
*Telephone
Cell Phone
*Email

QUESTIONS

* 1. System serial number:

2. Select the fundamentals education class that you would like to register for:

3. Select the cardiology education class that you would like to register for:

4. Select the vascular education class that you would like to register for:

5. Select the general imaging education class that you would like to register for:

6. Select the women's healthcare education class that you would like to register for:

7. Select the musculoskeletal education class that you would like to register for:

* 8. Training date:

* 9. Training location:

10. 2nd training date and location:

11. Dietary needs (if any):

12. Questions or comments:

* 13. I have read and agree to the travel policy.
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