Medical Events Training Registration

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Company Contact Information:
Name
First Last
Address
Street Address City State ZIP Code
Phone
Fax
Email
Company
Course Information:
Course Date(s) 1st Choice
Course Date(s) 2nd Choice
Duration
Course Description and Purpose
Nature of Surgical Procedure (if Applicable)
Estimated Number of Industry Representatives
Estimated Number of Physicians
Total Number of Attendees
Facility Usage
Location
- Regular BioSkills Lab - 2,000 sq. feet - 2 Stations
- Large BioSkills Lab - Weekend Only - 4-6 Stations
- Large Boardroom - Seats 12
- Small Boardroom - Seats 6
Number of Stations
Specimen(s) Needs:
Specimen Type(s) Needed and Quantity of Each
Points of Disarticulation (Be Specific)
Specimen Positioning:
Describe Positioning of Specimen(s)
Surgical Equipment Needed:
- C-Arm Imagine Machine
- C-Arm Technicians
- Suction Unit
- Endoscope
- Cautery (Bovie) Unit
- Headlamp
- Surgical Drill
- Other:
If Other Please List
If Other Please List
General Surgical Tools Needed
(Please List)
Special Instrumentation Needed
(Please List)
Audio/Video Needs
(Please Describe)
Catering:
Check all that apply
- Breakfast
If you selected Breakfast Please tell us what type you would like:
Type of Breakfast
- Lunch
- Dinner
- Snacks
Notes on Catering Needs
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