Training Follow-up -

Name(Required)

First Middle Last

Include your name as it appears on your identification card, including the middle name or initial. This will be included in your travel arrangements, such as hotel bookings and plane tickets.

Email(Required)

State Residence

State / Province / Region

Cell Phone

NPI Number(Required)

I need a hotel room.(Required)

Yes

I will attend the dinner the night before the course.(Required)

Yes

Travel Plans:(Required)

I want Pulmonx to book me a flight.

I will book my own train transportation.

I will be driving.

All flights must be booked through Pulmonx. We cannot reimburse air travel booked by third parties. You may submit a reimbursement request for other transportation plans. (See your email for the appropriate form.) If you need flights, please complete the information below.

Details Needed for Flights

Date of Birth

City of Departure

Preferred Airline (if applicable)

Preferred Frequent Flier Number (if applicable)

Preferred Home Airport Departure Date

Preferred Home Airport Departure Time

Preferred Seating (aisle, window, etc.)

Travel Request Notes