TECHNOLOGIST REGISTRATION FORM

ARKANSAS SOCIETY OF RADIOLOGIC TECHNOLOGISTS

60^th STATE CONVENTION

APRIL 9-12, 2008

EMBASSY SUITES, ROGERS, ARKANSAS

NAME _____________________________________________

ArSRT Member Number_______________ (This is not your state license number)

ADDRESS _______________________________________________________________

City, State, Zip______________________________________________________________________

HOME PHONE _________________________E-MAIL_________________________________

PRE-REGISTRATION DEADLINE: POSTMARKED BY APRIL 1, 2008. THERE WILL BE A $25.00 PROCESSING FEE FOR ON-SITE REGISTRATION.

REGISTERED & LICENSED TECHNOLOGISTS: Please CIRCLE desired registration days

ONE DAY REGISTRATION

Thursday ONLY $50.00

Friday ONLY (Lunch Included) $75.00

Saturday ONLY (Lunch Included) $75.00

TWO DAY REGISTRATION

Thursday & Friday (Friday Lunch Included) $95.00

Friday & Saturday (Lunches Included) $110.00

THREE DAY REGISTRATION

Thursday, Friday &Saturday (Fri. & Sat. Lunches Included) $129.00

LUNCH RESERVATIONS (required to guarantee meal)

I plan on attending the: ____ Honors Luncheon, Friday, April 11, 2008.

_____President’s Luncheon, Saturday, April 12, 2008.

____Extra Lunch tickets may be purchased for 25.00 each. ______Fri. ______Sat.

_____________________________________________________________________________

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 APRIL 1, 2008. SEATING IS NOT GUARANTEED FOR REGISTRATION FORMS POSTMARKED AFTER APRIL 1, 2008.

NO REFUNDS. EXTENUATING CIRCUMSTANCES MUST BE WRITTEN AND POSTMARKED TO THE ArSRT BY APRIL 5, 2008.