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User account request form

Please fill in this form to request your individual account for the Ziehm Academy Learning Platform. In doing so, you will get access to available training materials (e.g. eLearning modules) and can register for classroom training sessions. Personal details are required, whereas the other sections are optional based on your individual situation. After submitting this form, Ziehm Academy will check your request within 2-3 working days. You will receive email confirmation as soon as your registration request has been approved.

Please provide your personal data and your company address. Your email adress will be your user name for the learning platform.

This section is optional, however it will allow us to tailor the future training portfolio to your needs.

The details in this section are only required if you need a visa to travel to Germany for our training courses. We will provide you with an invitation letter for your local embassy that allows you to request a visa for a specific training session.

Please fill in this section if the details for invoicing are different from those given above.

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There are required fields in this form marked

Required field

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Choose your username and password

Your (company) email address Required field

Required field

The password must have at least 8 characters, at least 1 digit(s), at least 1 lower case letter(s), at least 1 upper case letter(s), at least 1 non-alphanumeric character(s) such as as *, -, or #

Password

Required field

Password (confirm) Required field

Required field

More details

Your (company) email address (confirm) Required field

Required field

First name Required field

Required field

Surname

Required field

City / Town (company) Required field

Required field

Country

Required field

Personal details

Title

Gender

Your job position Required field

Required field

Company name Required field

Required field

Street and house number (company) Required field

Required field

Post code (company) Required field

Required field

Phone number (e.g. +49 911 2172 0)

Fax number (e.g. +49 911 2172 390)

Which Ziehm C-arms do/ will you work with?

Ziehm Vision RFD 3D

Ziehm Vision RFD Hybrid Edition

Ziehm Vision RFD

Ziehm Vision R

Ziehm Vision(²) FD

Ziehm Vision(²)

Ziehm Vision(²) Vario/ FD Vario

Ziehm Vision(²) Vario 3D/ FD Vario 3D

Ziehm 8000

Ziehm Solo

Ziehm Vista

Ziehm Vario

Visa requirement details

Nationality

Date of birth

Day Month Year

Enable

Place of birth

Passport / ID-card number

Passport / ID-card issued on

Day Month Year

Enable

Passport / ID-card expiry date

Day Month Year

Enable

Passport / ID-card issuing authority

Invoicing details (only if different from above)

Company name

Name of contact person

Street and house number

Post code

City/ Town

Country

Phone number (contact person)

Email address (contact person)

Privacy Statement

I understand and accept the Privacy Statement Required field

Required field

Site policy agreement

Link to site policy agreement

I understand and agree Required field

Required field

Alternative product names may exist in some countries:
Ziehm Vision, Ziehm Vision FD, Ziehm Vision FD Vario, Ziehm Vision FD Vario 3D, Ziehm Vision Vario, Ziehm Vision Vario 3D Contact Legal Notice Site Owner Privacy