Registration
Form
The
“Mammography
Technologists CE Day”
We have 5 great lectures specific to Mammography Technologists!
(Others are
more than welcome to attend for CEUs)
February 4, 2012
8:00am
Palmetto Health Baptist
Auditorium
Name:
________________________________________________________________________
Credentials:
____________________ ASRT#:
_______________________________________
Address:
______________________________________________________________________
Email:
________________________________________________________________________
Phone #:
______________________________________________________________________
Registration is for this day only. Registration fees include breaks and lectures. This form must accompany each person attending the conference. Full payment must accompany each registrant. Advanced registration is preferred and must be post marked by January 28, 2012.
Registration
Fee Due on day of seminar or advanced registration must be received by January
28, 2012.
Fee: $50.00
Total
Enclosed: $_________________
*Please make checks payable
to “Palmetto Breast Imagers”.
Refund Policy: A request for a refund must be made in writing
and mailed to: Sherri Allsbrook, Palmetto Breast Imagers cannot guarantee
that all lectures will be held at the published time(s) or by the published
speaker(s). Palmetto Breast Imagers reserves the right to contact the
ASRT/ARRT to withhold credit for any returned checks, until the attendee
is once again a member in good standing.
*Checks returned
for nonsufficient funds will be assessed the cost of
the Conference plus a $50 fee.
Mail
to: Sherri Allsbrook