US Registration Form

GE Ultrasound Academy Registration
United States and Canadian registrants only

Customer Information: (* indicates a required field)
*Last Name:
*First Name:
*Degree:
Specialty:
*Facility Name:
*Street Address 1:
Street Address 2:
*City Where Facility is located:
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*Country:
*Telephone Number:
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*Fax Number:
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Administrator Information (If Applicable):
Name:
Telephone Number:
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*Session Requested: (Class registration closes 10 days prior to scheduled date.)

LOGIQ S8	LOGIQ 7
Jul 25-27, 2012/General Rad/Vascular U/S - Waukesha, WI
LOGIQ E9
Full May 21-23, 2012/General U/S with 3D/4D (Guest Spkr: Abd/Vasc Ultrasound) - Waukesha, WI Jun 18-20, 2012/General U/S with 3D/4D (Guest Spkr: MSK Ultrasound`) - Waukesha, WI Jun 20-22, 2012/General U/S with 3D/4D (Guest Spkr: Cardiac) - Waukesha, WI Jul 23-25, 2012/General U/S with 3D/4D (Guest Spkr: Vascular Ultrasound) - Waukesha, WI Aug 20-22, 2012/General U/S with 3D/4D (Guest Spkr: Abdominal Ultrasound) - Waukesha, WI Full Aug 22-24, 2012/General U/S with 3D/4D (Guest Spkr: GYN) - Waukesha, WI Sep 17-19, 2012/General U/S with 3D/4D (Guest Spkr: Vol Imaging in Womens Health) - Waukesha, WI
Voluson
Full May 15-16, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Intermediate) - Waukesha, WI (Guest Speaker: Reproductive Medicine) Full May 17-18, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Advanced) - Waukesha, WI June 12-13, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Intermediate) - Waukesha, WI June 14-15, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Advanced) - Waukesha, WI July 19-20, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Intermediate) - Waukesha, WI August 14-15, 2012/Voluson 3D/4D in Ob/Gyn Sonography (Intermediate) - Waukesha, WI August 16-17, 2012/Voluson 3D/4D in Ob/Gyn Sonography (IAdvanced) - Waukesha, WI
Vivid 7	Vivid 5

Wait List	- I am interested in being put on the wait list for the following course:
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Sales Representative Information
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