Super User Training Program Nominations

Please complete the form in order to nominate a Super User for an upcoming training session.

* required fields

CathWorks Representative Email*

Medtronic Sales Representative*

Medtronic Clinical Specialist

Account Name*

Account Number*

Date of First FFRangio Case at Account*

Total Number of FFRangio Cases Performed at Account*

Have Staff from this Account Attended a Previous Super User Training?*

Super User Nominee 1 - Name*

Super User Nominee 1 - Email*

Has Super User 1 Been Officially Certified?*

Number of FFRangio Cases Performed by Super User 1 in the Past 60 Days*

Super User Nominee 2 - Name

Super User Nominee 2 - Email

Has Super User 2 Been Officially Certified?

Number of FFRangio Cases Performed by Super User 2 in the Past 60 Days

Select Super User Training*

How Often Do You and Your Medtronic Counterpart(s) Touch This Account?*

Additional Comments

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.