Ultrasound Certificate Program - Enroll

Instructions: Unless not applicable, all fields are required.
Prefix:
First:
MI:
Last:
Suffix/Affiliation:
Address:
City:
State: Zip:
Country:
Telephone:
Fax:
E-mail Address:

Mailing Address (if different):
Mailing City:
State: Zip:
Mailing Country:
Telephone:
Fax:

State/National DVM License#:
Location:
Corporate Sponsor:
Ultrasound Make & Model:
Transducers Available:
Completed Courses:
Basic Abdomen:
Date: Instructor:
Echocardiography:
Date: Instructor:
Advanced/Intermediate Abdomen:
Date: Instructor:

Preferred Format of Case Submission:
(select one)
Preferred Method of Billing (US Funds):

Upon enrollment and payment of registration fees, you will receive a start date, deadline for certificate program completion, and a certificate user name and password you can use to check your progress ("My Certificate Program).
I have read and agree to the terms and conditions of this Certificate Program