North Texas Society of Radiation Therapists

NORTH TEXAS SOCIETY OF RADIATION THERAPISTS 2011 FALL SYMPOSIUM

This form is printable from the Windows FILE menu.

FULL NAME ___________________________________________________________

HOME MAILING ADDRESS _____________________________________________

_______________________________________________________________________

HOME PHONE NUMBER _____________________________________

EMAIL ADDRESS ___________________________________________

PLACE OF EMPLOYMENT _____________________________________________

WORK PHONE NUMBER_____________________________________

ADVANCE REGISTRATION FEE:

______NTSRT member $45
______Non-member $55
______Student $25

PLEASE NOTE:
If registering as a member, a copy of your membership card MUST accompany pre-registration materials or pre-registration materials will be returned.

Make check payable to: NORTH TEXAS SOCIETY OF RADIATION THERAPISTS

Return registration fee and application form to:

North Texas Society of Radiation Therapists
c/o Betsy Shaw, Sec.
1427 Crownhill Drive
Arlington, TX 76012

For information email ntsrtweb@sbcglobal.net