CCI Volunteer Interest Form

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* 1. Please provide your contact information:

First Name *

Last Name *

City/Town *

State/Province *

Country

Email Address *

Phone Number *

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* 2. CCI Credentials Held (select all that apply):

Advanced Cardiac Sonographer (ACS)

Certified Cardiographic Technician (CCT)

Certified Rhythm Analysis Technician (CRAT)

Registered Cardiac Electrophysiology Specialist (RCES)

Registered Cardiovascular Invasive Specialist (RCIS)

Registered Congenital Cardiac Sonographer (RCCS)

Registered Cardiac Sonographer (RCS)

Registered Phlebology Sonographer (RPhS)

Registered Vascular Specialist (RVS)

None

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* 3. Other Designations Held (select all that apply):

None

CCDS

CEPS

LPN/LVN

RDCS

RDMS

RVT

Other (please specify)

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* 4. What year did you earn your first cardiovascular credential?

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* 5. Work Experience Specialty (select all that apply):

Cardiac Catheterization

Cardiac Electrophysiology

Cardiac Rhythm Monitoring

Echocardiography

EKG Stress Testing and Holter Monitors

Pediatric/Congenital Cardiac Ultrasound

Phlebology/Venous Ultrasound

Vascular Ultrasound

Other (please specify)

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* 6. Select which describes your current work setting:

Hospital

Academic Medical Center

Clinic

Hospital Outpatient

Doctor’s Office

Not employed or Retired

Other (please specify)

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* 7. Do you currently participate in presenting or developing resources that's purpose is to prepare individuals to take or pass a CCI examination?

Yes

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* 8. Upload the most recent copy of your CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File