Imaging Symposium Registration | Florida Hospital College of Health Sciences

Registrant Information

Salutation:

Full Name: *

Mailing Address: *

City: *

State: *

Postal Code: *

Daytime Phone: *

Evening Phone:

Email: *

Position/Title:

Employer:

State License # or ARRT#:

Please enter your certification number.

Attendee Survey

How did you learn about our symposium?:

If you have any special ADA needs, please specify:

Registration Fees

Registration Fees
Early Registration (Credit Card or Check)^*	$75
On-Site Registration (Cash or Check)	$100

^*All early registration payments must be received by September 9, 2011 or the attendee will be charged the $100 on-site fee. All registration fees are non-refundable.

Methods of Payment

Call (407) 303-1631 with Credit Card Payment.
All major credit cards accepted.
Mail a check/money order payable to:

Florida Hospital College of Health Sciences
Attn. Anita Spry
671 Winyah Drive
Orlando, FL 32803

Please write "Imaging Symposium" on your check/money order.

Confirm Payment: *

I will call with Credit Card Payment.

I will mail a check/money order.

Payment must be received by September 9, 2011 or attendee will be charged the $100 on-site fee.

CE Certification

Florida Hospital College of Health Sciences designated this educational activity for 6 Technical Continuing Education Credits. Technologists must sign in before and sign out after each session in order to receive full credit.

Do you acknowledge that you have read and understand these guidelines for CE certification?: *

Yes, I understand.