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ISSRT CONTINUING EDUCATION EVENT REGISTRATION
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1.
FIRST NAME
(Required.)
*
2.
LAST NAME
(Required.)
*
3.
Are you an ISSRT member?
If you’re not a member, there is a $15 fee for participation- see PayPal QR code or pay cash at time of event.
(Required.)
Yes
No
4.
ISSRT Membership Number
*
5.
Email Address
(Required.)
*
6.
Current Status:
(Required.)
Student
Radiology Educator
Radiologic Technologist
Other (please specify)
*
7.
How did you hear about this event?
(Required.)
ISSRT Website or ISSRT Social Media page
Radiography Program Notification (share which program in the comment box below)
Fellow Technologist (share their name in comment box below)
Other (include details in comment box below)
Comments
Event payment ($15 for non-members) - PayPal
**Include "Northern Region CE Event" in the notes section when paying**
