Surgical Technologies Medical Education
Online Registration

Thank you for your interest in the Midas Rex® Institute workshops. Please complete the form below and click on the submit button to submit your request to register for an ORP workshop. To help speed the process and ensure efficient registration, complete all items marked with a red star. You will be contacted regarding the availability of the requested workshop and the status of you registration request.

Please ensure that you will be granted the requested time off from work to attend this course before registering. Because Medtronic is covering the expenses for attendees, please verify that you are not violating any policies that your hospital may have in place by attending.

By participating in this event, participants acknowledge that Medtronic may be providing reasonable value in the form of, for example, flights, transportation, food & beverage, lodging, and educational items, associated with this event. Participants further acknowledge that this value may be disclosed in accordance with applicable U.S. Federal and State Laws. If you would prefer to opt out of receiving these transfers of value, please notify your Medtronic event contact.


Fields marked with * are required.


Workshops:
*Date of Workshop:

Personal information: (The more information you provide, the better we can serve you.)
*Prefix:
*First Name: (As it appears on your photo ID)
*Middle Name: (As it appears on your photo ID)
*Last Name: (As it appears on your photo ID)
*Preferred Name: (as you wish it to appear on your certificate, badge, etc.)
*Professional Title: (RN, CST, etc.)
*Are you an OR Manager?:
*Professional License Number: (Enter N/A if not licensed - You must provide a license number in order to receive a certificate which includes contact hours)
*E-Mail Address:
*Please re-enter your
E-Mail Address for verification:
*Cell Phone Number:
*Hospital, Institute or Company Affiliation:
*Affiliation Address:
*City:
*State:
*ZIP/Postal Code:
*Scrub Size:
Special Food Restrictions:
Sales Rep:
Questions or Comments:

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