Location |  Contact

This form will allow you to submit a registration request on-line. Submitting your request does not confirm the class(es) and/or date(s) you are requesting. Once your registration request is processed you will receive an email confirmation.

If you experience any difficulties with your submission or have any questions regarding registering on-line, please contact your local Varian Office.

Student Information

All fields are required
Salutation  
First Name Last Name
Job Title * Email
Address 1 City
Address 2 (optional) State / Prov.
Zip / Postal Code Country
Phone / Cell #  
* Must be a valid business email address, no AOL, Yahoo, etc. email domains accepted
 

Facility Information
I am a full-time employee of the facility named below. All fields required
Facility/Hospital Department
Facility Address City
Address 2 (optional) State
Zip/Postal Code Country
Phone (Work) Fax
 

Class Approval Process
Management approval required for class confirmation. All fields required
Hospital Manager/
Administrator Name
Hospital Manager/
Administrator Title
Hospital Manager/
Administrator Email
* Must be a valid business email address, no AOL, Yahoo, etc. email domains accepted
 

About Your Varian Equipment
Student must provide information relative to current registration request.
  Machine Type Serial Number Actual or Anticipated Acceptance Date
Accelerator Accessories Serial Number Actual or Anticipated Acceptance Date
Information Management Version Actual or Anticipated Acceptance Date
Treatment Planning Version Actual or Anticipated Acceptance Date
 

Course Enrollment Request
Student must provide information relative to current registration request.

Courses Offered at Clinical Sites
Date Selection (please select a first, second, and third choice)
First Choice
Second Choice
Third Choice

Technical Maintenance
Date Selection (please select a first, second, and third choice)
First Choice
Second Choice
Third Choice

Support
Date Selection (please select a first, second, and third choice)
First Choice
Second Choice
Third Choice

Operations
Date Selection (please select a first, second, and third choice)
First Choice
Second Choice
Third Choice
 

Payment Information

Please do not send checks. You will be invoiced at the end of the course.
If your contract includes tuition, please specify the agreement information below:
Purchace Order
Sales Order
Quote Number 		Enter the Purchase Order, Sales Order or Quote Number
OR
Please charge my tuition against Course Purchase Order
An invoice will be sent after the class has been completed.

 

 

Contact Varian Oncology

Varian Oncology Headquarters
Tel: 1.650.424.5700
Fax: 1.650.493-5637
E-Mail: oncology@varian.com

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Production of any of the material contained herein in any format or media without the express written permission of Varian Medical Systems is prohibited.

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