Texas Society of Radiologic Technologists, Inc. (TSRT)

Reginal Seminar On-line Registration Form
HOME | About TSRT | Contact TSRT | Join TSRT | Executive Office | Election 2012 | TSRT 2012 | Career Center | Educators | Events | Legislative | Links | Membership Roster | Documents / Publications | Need Speakers? | Recognition | Students | Subordinates | Sponsorship

**REGISTRATION FORM**
TSRT Regional Conference
Saturday February 11, 2012
1pm - 4pm
Amarillo, TX 
 
3 Hrs CE Credit (s)
12:30  pm     Check-in
  1:00 pm      Imaging: We have Come A Long Way (3.0 CEU's)
 
Please Complete the Form Below

First Name
Last Name
Professional Credentials
Address
City
State
Zip Code
Day Phone (111-222-3333)
Evening Phone (111-222-3333)
Employer / School
Email
Date of Birth (MM/DD/YYYY)
SexMale
Female
Registration Fees / TypeTechnologist / Therapist
Student
Other
Pre-Registration - $27
On-site - $35
Total Payment (Add the Checked Boxes)
Credit Card Payment OptionsVisa
MasterCard
Discover
Card Number
Expiration Date (MM/YY)
Security Code Digits
Name on Credit Card
  

Click Submit when complete.
 
No Refunds after February 6, 2012
 

Pre-Registration ends February 6, 2012

Enter supporting content here