Surgical Technology Questionnaire Form

Surgical Technology Questionnaire

Here is your opportunity to receive a FRE'E "Signed Edition" printed hardcopy of the Surgical Tech Success Handbook with the Surgical Tech's Little Black Book & the Surgical Tech Success Quick Link Resource Library on CD

OR the complete Surgical Tech Success e-Book Package instant download

OR all three of the Surgical Tech Success books on a CD

PLUS, one lucky entrant will win a 30minute Telephone Interview with Robert Prince, CST, Author, Certified Surgical Technologist, Founder & CEO SurgicalTechSuccess.com.

Yes, that's right, Robert will personally call one lucky entrant and that person will be able to "Interview" Mr. Prince for 30 minutes. You'll have the opportunity to ask Mr. Prince anything you can think of about Surgical Technology, the Career Field, How To Succeed, and/or his Career as a CST.

Take a moment to complete the questionnaire below and stay tuned...

Even if you already own any of the SurgicalTechSuccess.com publications,
you are still eligible.

ALL WINNERS WILL BE NOTIFIED by MIDNIGHT - SUNDAY, AUGUST 27th, 2006-

PLEASE NOTE:
Only one entry/submission per person. All duplicate entries will automatically be deleted.

Surgical Technology Information Questionnaire

Please note that all fields followed by an asterisk must be filled in.

I'd like to know more about...

My Specific Question Is:

Status
(Check All that Apply)*

	Student
	Potential Student (Thinking about it)
	Future Student (Have enrolled or on a waiting list)
	Educator
	Experienced (currently working in the field)
	Certified
	First Assistant
	Nurse (RN - LPN)
	Working ST & Currently going to School
	Other~

My Career Goals Are
(Check All that Apply)*

	Graduate from ST school & then decide
	Surgical Tech Traveler
	Become a Surgical First Assistant
	Become a Surgical Nurse
	PA (Physician Assistant)
	MD
	CRNA
	Will be content as a "Career Surgical Tech"
	Start my own Surgical Business utilizing my Surgical Tech Education
	Medical Sales
	I just don't know at this point
	Other~

Please rate your Overall Satisfaction with the information & publications you've received from SurgicalTechSuccess.com*

	Very Satsified
	Satisfied
	Somewhat Satisfied
	Dissatisfied
	No Comment

What can SurgicalTechSuccess.com provide in order to assist your current status/position?

Please specify any Products or Information you'd like SurgicalTechSuccess.com to offer

Which of the Surgical Tech Success books/publications have you read?
Please Note, EVERYONE is eligible to win!
(Check All That Apply)*

	Surgical Tech Success Handbook
	Surgical Tech's Little Black Book
	Surgical Tech Success Quick Link Resource Library
	Surgical Tech's Questions, Answers, Tips, & Resources
	I've received the books but haven't had a chance to read them yet
	I haven't read any of the books
	I'm just reading the Newsletters for now

If chosen, which edition do you prefer to receive?*

	Printed - Signed Hardcopy of the Surgical Tech Success Handbook w/eBooks on CD
	The Complete Instant Download Package
	The CD copy of all three books
	The 30 minute Telephone Interview of Mr Prince

Name*

E-mail Address*

Send To:

If selected as a winner, please indicate where you would you like your Handbook, CD's, or e-Books sent?

E-Mail Address

Street Address

City

State/Prov

Zip/Postal Code

Home Phone

Business Phone

Fax

HOW CAN WE IMPROVE OUR WEBSITE?
Additional Comments, Questions, Suggestions?

How did you here about SurgicalTechSuccess.com?*

I Agree*

By checking this box, I affirm the information I am submitting is true and accurate to the best of my knowledge.

Surgical Technology Questionnaire

Surgical Technology Information Questionnaire

THANK YOU FOR YOUR ENTRY!GOOD LUCK!!!

THANK YOU FOR YOUR ENTRY!
GOOD LUCK!!!