Preregistration Thank you for your interest in attending one of our onsite training courses. Please complete this brief customer qualification review form. Name* First Last Title*Facility*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Select Desired Course* Patient Monitoring Systems Service Seminar EEG Fundamentals & cEEG in the Critical Care EEG, PSG, EMG, IOM Service Seminar Advanced Polysmith Training NKV-550 Service Seminar NKV-440 Service Seminar NKV-330 Service Seminar Select which products your facility utilizes EEG PSG EMG IOM Desired course date*Do you qualify to attend this training for free?* Yes, my facility pre-purchased training. Yes, my facility’s equipment is under warranty. No, I will pay with a credit card or purchase order. I don’t know. Please check for me. This field is hidden when viewing the formDo you qualify to attend this training for free? Yes, my facility pre-purchased training. Yes, my facility’s equipment is under warranty. No, I will pay with a credit card or purchase order. I don’t know. Please check for me. This field is hidden when viewing the formOne Qualifying Product per line with purchase date or P.O. #Cancellation Policy Consent* I agree to the Booking policy.CancellationNO-SHOW POLICY: Nihon Kohden LLC no-show policy stipulates that the full tuition fee will be charged if a participant fails to attend a scheduled class without providing a written minimum 10 days' notice. Should a tuition waiver have been used during registration, the full tuition fee will be applied, or the waiver will be forfeited. This policy is in place to acknowledge the resources and preparation invested in the arrangement. Your understanding and cooperation in adhering to this policy are greatly appreciated. CLASS CANCELLATION: Nihon Kohden America, LLC retains the authority to cancel any seminar or class at its discretion. In the event of cancellation, registered attendees will receive timely notification, and their tuition will either be refunded or applied towards a future seminar or class.Privacy Policy Consent* I agree to the privacy policy.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.