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Info@Amendia.com

AMENDIA Sales & Product Training Course Registration

Select which training you are registering for(*)
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First Name(*)
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Last Name(*)
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Email(*)
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Phone Number(*)
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(Please enter your phone number including area code: XXX-XXX-XXXX)

Referred By(*)
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Name of Distributorship(*)
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Are you new to spine? (*)

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How long have you been selling spinal products?(*)
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Are you currently up-to-date with a vendor credentialing group, i.e. Reptrax or Vendormate?(*)

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How well do you understand basic medical terminology? (1-none, 5-advanced)(*)

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How familiar are you with spinal anatomy? (1-none, 5-very experienced)(*)

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Are you able to read spinal imaging such as fluoroscopy, MRI or CT scans? (*)

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Are you currently selling spine products? (*)

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Which company? (*)
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What Products? (*)
Please enter the products you sell.

Is your intention to sell iOFlex? (*)

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Are you currently selling biologics products? (*)

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Which company? (*)
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What Products? (*)
Please enter the products you sell.

Are you currently under contract with Amendia or Spinal Elements?(*)

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Which products are you selling?(*)
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Please give a brief description of your spinal device sales experience.(*)
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Are you local to the Atlanta area?(*)

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How will you be traveling?(*)

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Airline Name(*)
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Flight #(*)
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Departure Airport(*)
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Departure Time(*)
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(Please include AM or PM)

Departure Date(*)
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Arrival Airport(*)
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Arrival Time(*)
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Arrival Date(*)
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Return Flight Airport(*)
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Return Flight Time(*)
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Return Flight Date(*)
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Do you require accommodations?(*)

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Acknowledgement

I acknowledge that:

  • Spinal Elements will reimburse for a $20 dinner stipend Sunday through Thursday evening, when meals are not provided.
  • Spinal Elements is to provide and arrange accommodations Sunday through Thursday evening, provided the attendee’s primary residence
         is not local to the Atlanta Metropolitan area.
  • Spinal Elements is to provide and coordinate ground transportation to and from training beginning Monday morning through Friday
         morning. I am responsible for arranging all other travel arrangements, including flight and arrival/departure ground transportation.
         Reasonable public transportation (Uber, taxi, etc.) to and from the airport is reimbursable according to the policy below.
  • Attendees must pass the exams and participate in class activities in order to sell our products and be reimbursed for economy airfare.
  • All expenses must be supported by a completed Expense Form, W9 and itemized receipts to be reimbursed. Checks will be sent 30 days
         after submission of all completed paperwork to cgriffin@spinalelements.com
  • Attendees are responsible for studying material before training, as well as bringing a laptop or tablet to view the material and take tests
         on during training.
  • In order to attend the training, I understand that I am required to complete all pre-training course material with a score of 90% or greater
         prior to August 7, 2017.
(*)
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Electronic Signature(*)
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Date(*)
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