1. Name of your facility or facilities:

2. How many Registered Technologists (RT's) are employed at your facility or facilities?

3. How many non-RT's are employed at your facility or facilities?

4. How many non-RT's will require training?

5. Which region would you prefer the training to be conducted: Western, Central or Eastern North Dakota?
   Please select one: Western Central Eastern

              When finished, click the "Submit" button to send your response, or the "Reset" button to start over.