TRAINING REGISTRATION

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    To register, please complete the form below. Please complete a separate form for each person from your hospital attending the class. Any field with an asterisk (*), is required.

    Your Hospital's Name*

    PO #

    Contract #

    Hospital Address Line 1*

    Hospital Address Line 2

    City*

    Select State

    Zip Code

    Your Name

    First Name*

    Last Name*

    Phone*

    Email*

    Choose Class*

    Name of people attending the class

    Attendee #1

    Full Name*

    Email

    Dietary Restrictions

    Name of Supervisor

    Title of Supervisor

    Attendee #2

    Full Name

    Email

    Dietary Restrictions

    Name of Supervisor

    Title of Supervisor

    Attendee #3

    Full Name

    Email

    Dietary Restrictions

    Name of Supervisor

    Title of Supervisor

    If you do not receive a email verifying your registration, please call 800.296.7382.

    NOTE: By submitting this form to Pevco, you are confirming that your hospital staff is attending the training class indicated above. If your staff is unable to attend, please notify Pevco within 3 weeks of class date or a $375 cancellation fee will apply.

    Pevco upgrades existing pneumatic tube systems, even those made by other manufacturers.

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