North Texas Society of Radiation Therapists

NORTH TEXAS SOCIETY OF RADIATION THERAPISTS 2010 SPRING 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 Angela Saporito, Sec.
5333 Fossil Creek Blvd #1225
Haltom City, TX 76137

For information email ntsrtweb@sbcglobal.net

ADVANCE REGISTRATION FEE DEADLINE : MARCH 25, 2010