Surgical Technologies Medical Education
Online Registration for Courses Offered at Medtronic Facilities

Please complete the following registration form ONLY if you are registering for courses offered at a Medtronic Location.

To register for an Offsite Combined IGS/NIM workshop, please contact Berneida.f.owens@medtronic.com to request a registration form.

 

We look forward to seeing you. If you have questions about registration please contact:

Berneida Owens
904-279-7510
FAX: 904-281-2771
Berneida.f.owens@medtronic.com


Fields marked with an * are required


Workshops:
*Date of Workshop:
*Courses:

Personal information: (The more information you provide, the better we can serve you.)
*Name: (must match name on Driver’s License)
*Gender:
*Professional Title: (RN, Cert. Surg. Tech., etc.)
*Nursing License Number:
*State of issuance:
* E-Mail Address:
*Phone (preferably cell for contact while attending course)
*Hospital Affiliation:
*Affiliation Address:
*City:
*ZIP/Postal Code:
*State:
*Home airport of choice:
*Preferred departure time:
Name of your Medtronic sales rep:

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