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Registration of Interest Data Base Entry
To have your details added to our data base, please fill in personal details and questionnaire, plus any further comments you may have on programs ideas and click on submit. We will only contact you or send information about those topics in which you have shown interest.

Title: Full Name:

Occupation:

Home Address:

Work Address:

Home Phone: Work Phone:

Mobile Phone: Fax:

Email Address:

Questionnaire
Do you work?
Full Time ---
Part Time ---
   
What applications of ultrasound do you practice?
General ------
Obstetrics-----
Vascular--
Echo--
Msk ----------
Emergency ---
Other -----
 
If you are a Sonographer - do you?
A. Write interim reports ------
B. Discuss results with patients
Need help with ---A. B.
How many years have you been scanning?
0-2
2-5
5-10
10+
Are you involved in workplace training?
Yes
No
Would like to be
Would you like to suggest a new program topic?
Yes
No
Write new topic suggestion in comments
Would you like to receive AIU newsletters via email?
Yes
No
 
IF YOU WISH TO BE REMOVED FROM OUR DATA BASE PLEASE CHECK BOX

 

Comments

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