Email registration for
Full Field Digital Course

MD or DO $300

RT $175

RT $125 if attended an Achieving Quality Imaging Initial Training program PRIOR to this date in 2008.

Method of Payment sending:
Facility Check
Personal Check
Call in credit card

Name for Certificate*

Name for Badge*

Home Address*

City*

State*

Zip*

Home Phone*

E-mail*

Facility Name*

Facility Address*

City*

State*

Zip*

Work Phone*

Work Fax

Questions:

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