Belimed USA - Service Training Registration

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Please fill out the information below:

1. Personal Information:
*Name:	Title:		*Hospital:

*Address:	*City:		State:

*Zip:	*Email:

*Phone:	Fax:

*Required. To register for an event you must provide your Name, Address, e-mail address and your phone number.


2. Class
Which class or classes do you plan to attend?:		Washers Disinfectors & Automation
		Sterilizers
		Cart Washer

How will you be traveling?:


What dates are you interested in attending?:

How do you plan to pay?:

3. Travel & Lodging Participants are responsible for their personal travel arrangements. Hotel recommendations and reservations will be made by Belimed, Inc., but it is your factily's responsible to arrange payment for your accommodations.


Comments/ Questions:

If you have any questions, please email training@belimed.us Thank you. We look forward to your visit.

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