Information to move into database/form

Name

Address

Primary Phone Number [cell/home/work]

When did you begin performing ultrasounds?

Are you an RDMS [registered diagnostic medical sonographer]

Member of the SDMS? yes/no

Student? yes/no
If so, what year in program and where?

Have you previously participated in a short term mission trip? yes/no
If so, when and where?

Why are you interested in attending a HI course?

Which HI courses you have attended?

Bilingual? Yes/no
If so, what languages?

Hope Imaging Inc., a non-profit agency which provides ultrasounds to underserved populations around the world.