Training Course Registration

* Dates of Training you are interested in:
* Location of Training:
First Name:
Last Name:
Address
City
State
Zip
Date of Birth
Age:
Cell Phone Number
Home Phone Number
*Email Address
Name of Pregnancy Center
Director's Name
Nurse Manager
Organization Address
Organization Phone Number
Organization Email
Highest Level of Degree
Type of Degree
Year of Degree
Regristry or Nurses Licence #
Are you registered in more than one field?
If yes, please list here:
Have you had previous ultrasound training?
What organization provided your training?
What year did you recieve your training?
Did you recieve a certificate of compentency?
Approximately how many scans do you preform a month?
Have you recieved a refresher course?
What year?
Do you have a sonographer available to assist you in providing ultrasound?
Do you have a licenced nurse or physician who has been certified to provide limited ultrasounds?
What is the manufacture and year of your ultrasound system?
Are you looking for a new or used system?
I would like to share the following with a participant

Sound Wave Images, Inc.
Attn: SHARI RICHARD - 6542 Lakeshore Road, Lake Port, MI 48059

© 2024 Shari Richard