EVENT INQUIRY
Surgical Training Institute Event Schedule
*Required fields
Personal/Event Information
First Name:
*
Last Name:
*
Title:
*
Company:
*
Country:
*
Phone Number:
Email:
*
Event Purpose:
-------
Surgeon training
Equipment demonstration
Sales/marketing training
Investigator Training
Other
Number of Attendees:
LOCATION OF EVENT
Venue:
-------
Medical Convention
Healthcare facility
Other
City:
State:
---
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
NE
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
Date of Course:
Time of Course:
Event Description: :
Auditorium/classroom needed for Didactic session?
yes
no
Catering needed?
yes
no
Training Equipment Requirements
C-Arm
yes
no
Power tools
yes
no
Surgical Hand Instrumentation
yes
no
Endoscopic/Laparoscopic Tower
yes
no
Ultrasound
yes
no
Audio and visual equipment
yes
no
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