Registration - Duluth Breast Imaging Confernce

Welcome to the online registration for our 2014 Duluth Breast Imaging Conference.  To register for the conference, please fill out the registration form below.

If you would prefer to register by mail, please print out the mail-in registration form, fill out the required information, and send to:

     Achieving Quality Imaging
     W140 N8917 Lilly Road
     Menomonee Falls, WI 53051

 

*Required Fields

*Which Seminar Days Are You Attending

-- Please Choose a Program -- Friday ONLY Saturday ONLY Friday AND Saturday Please select an item.

*Registering As

Radiologic Technologist
Radiologist Please make a selection.

*Payment Method

-- Please Choose a Payment Method -- Facility Check Personal Check Credit Card Over the Phone Paypal Checkout Please select an item.

Personal/Facility Information

*Name For Certificate: *Name For Badge: *Home Address: *City: *State/Province: *Zip/Postal Code: *Home Phone: *Cell Phone: *Email: Facility Name: Facility Address: Facility City: Facility State/Province: Facility Zip/Postal Code: Work Phone: Work Fax:

Questions/Comments

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