Clone of Course Registration Form

Register for your Course

Thanks for choosing Colorado Surgical Institute — we’re excited to have you here.You’re just a few steps away from securing your spot. We know this form looks a little long, but every question has a purpose. Your answers help us match you with the right mentor, prep your cases, personalize your surgical experience, and make sure you get the most out of your time with us.Take your time, fill it out completely, and know that we’re already looking forward to welcoming you to the course.If you run into any issues, reach out anytime — we’re here to help.
Attendee Name*

First NamePreferred/Nick nameLast Name
Phone Number*
Email*
example@example.com
Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Help us make your CSI experience even cooler
Do you have any dietary restrictions?*
What types of snacks do you like?
What is your favorite caffeinated beverage?
What size of scrub top do you wear?*

XSSMLXLXXLOther
What size of TShirt do you wear?*

XSSMLXLXXLOther
What should we know to help your experience be more pleasant?
How did you hear about Colorado Surgical Institute?*
Additional Comments
By checking this box, you consent to receive text messages from Colorado Surgical Institute (CSI) regarding course updates, reminders, and other relevant communications.

Text me!

My Products

Implant ComplicationsThis lecture course is a two-day experience focused on real-time surgical decision-making when cases don’t go as planned. Through live clinical discussion, mentor-guided insight, and honest breakdowns of what went wrong and why, doctors leave more confident, prepared, and ready to manage complexity in their own practices.

$2,900.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Register for your Course

Help us make your CSI experience even cooler