Service Training Classes – Samsung Healthcare USA

Registration Information
Name*
First Last
Email*
Company*
Phone*
Invitation Letter
Do you need an invitation letter?*
Full Name*
First Last
Citizenship*
Passport Number*
Date of Birth*
Month
Day
Year
Passport Date of Issue*
Month
Day
Year
Passport Date of Expiry*
Month
Day
Year
Emergency Contact Information
Hotel
Phone
Supervisor/Backup Contact Name*
First Last
Supervisor/Backup Phone #*
Do you have X-Ray Safety Training?*
- Yes
- No
Please provide certificate
Max. file size: 50 MB.
If No please click on the following link and complete the Quiz. Please bring quiz with you to give to the instructor on the first day of class.
Course Information
Modality Type? (Please use the calendar below to see if space is available)*
Class Title and Date*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Unique ID

Registration Information