Program Registration

Electromagnetic Navigation Bronchoscopy Physician Training Program

Location:
superDimension, Inc.
161 Cheshire Lane, Suite 100
Minneapolis, MN 55441

ALL fields are required for registration

ENB Training Dates: September 10-11, 2010 October 8-9, 2010 November 12-13, 2010 December 10-11, 2010

First Name (must match government ID):

Middle Name (must match government ID):

Last Name (must match government ID):

Date of Birth (required for flight logistics):

Gender Male Female

Hospital Affiliation Name:

Address:

City, State, Zip:

Professional Information (select one):
Pulmonologist
Thoracic Surgeon
Radiation Oncologist
Other (Nurse, RT, Technician)

Travel Information
(Travel will be arranged for arrival into Minneapolis-St. Paul (MSP) the day prior to the training program.)

Departure Airport:

Departure Time: Morning Afternoon Evening

Contact Information

Phone:

Email: