STUDENT REGISTRATION FORM

(PLEASE PRINT)

ARKANSAS SOCIETY OF RADIOLOGIC TECHNOLOGISTS

STATE CONVENTION

APRIL 14-17, 2010

CROWNE PLAZA, LITTLE ROCK, ARKANSAS

NAME _____________________________________ArSRT Member Number____________

ADDRESS______________________________________________________________

City, State, Zip___________________________________________________________

HOME PHONE _________________________E-MAIL_________________________________

PRE-REGISTRATION DEADLINE: POSTMARKED BY MARCH 15,2010. THERE WILL BE A $25.00 PROCESSING FEE FOR LATE REGISTRATION AND A $60 PROCESSING FEE FOR ON-SITE REGISTRATION.

WHICH SCHOOL DO YOU ATTEND?_______________________________________________________

I AM PARTICIPATING IN THE:

LARRY DAVIS MEMORIAL QUIZ BOWL _____________

SCIENTIFIC ESSAY COMPETITION _____________

SCIENTIFIC EXHIBIT COMPETITION _____________

MEETING ATTENDANCE: THURSDAY____ FRIDAY____ SATURDAY____

QUIZ BOWL OBSERVATION _____________

PARTICIPATING STUDENT FEE: $35.00

This includes 3-day convention registration,quiz bowl observation and entry fee for any competition. LUNCH SATURDAY IS NOT INCLUDED. LUNCH TICKETS ARE $25.00 AND SEATING IS LIMITED.

STUDENT LUNCH RESERVATIONS

President’s Luncheon, Saturday, April 17, 2010. Cost is $25 per ticket. Number of tickets____.

_____________________________________________________________________________

MAKE CHECKS PAYABLE TO ArSRT & MAIL WITH REGISTRATION FORM TO: ArSRT, PO BOX 241492, LITTLE ROCK, AR 72223

ALL PARTICIPANTS MUST BE MEMBERS OF THE ArSRT BY JANUARY 31, 2010.   SEATING IS NOT GUARANTEED FOR REGISTRATION FORMS POSTMARKED AFTER MARCH 15, 2010.

NO REFUNDS. EXTENUATING CIRCUMSTANCES MUST BE WRITTEN AND POSTMARKED TO THE ArSRT BY APRIL 1, 2010.