Thank you for your interest in a training session & shadow day with Ann, RN CANS and Dr. Zemplenyi, MD. Please fill out the form below and you will be contacted with more information and how to register.

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* 1. Full name

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* 2. What certification do you have?

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* 3. Birth date

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* 4. Phone Number

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* 5. Email

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* 6. Are you working as an injector? How many years of injecting experience do you have?

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* 7. Are you liscensed in the state of Washington?

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* 8. What do you hope to learn from this training?

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