Contact Information
*
Prefix:
Dr.
Mr.
Mrs.
Ms.
*
First Name:
*
Last Name:
*
Job Title:
*
Work Phone:
*
Work Email:
Your Laboratory
*
Name:
*
Address:
*
City:
*
State:
*
Zipcode:
Medical Director
*
Prefix:
Dr.
Mr.
Mrs.
Ms.
*
First Name:
*
Last Name:
*
Phone:
*
Email:
Laboratory Manager
Prefix:
Dr.
Mr.
Mrs.
Ms.
First Name:
Last Name:
Phone:
Email:
Microbiology Supervisor
Prefix:
Dr.
Mr.
Mrs.
Ms.
First Name:
Last Name:
Phone:
Email:
Briefly explain how you expect to benefit professionally by completing the 2017 Iowa Clinical Laboratory Safet-eTraining course package
*
Briefly explain how you hope to improve safety in your laboratory after completing the 2017 Iowa Clinical Laboratory Safet-eTraining course package
*
Do you have an official role in laboratory safety? If so, please describe your role below. (Answering no does NOT disqualify you from this training program.)
*