ASNM REGISTRATION FOR THE 2012 ANNUAL MEETING
  

Registration is a two-step process.
1. Complete registration form.
2. Payment (check, Pay Pal or Credit Card)
IF PAYING BY CHECK, PLEASE MAIL PAYMENT TO: PO BOX 2293,BIRMINGHAM, ALABAMA, 35201-2293

Step 1: Registration Form

 
Name
Home Address
Home City
State
Zip
   
Work Address
Work City
State
Zip
Work Fax
E-mail
   

Which Radiopharmacy do you use? (The ASNM can send information through the delivery boxes.)

Members:
       VOICE credits      $150 (+$50 on-site or after 03/15/11)

      ALSO INCLUDES YOUR 2011 MEMBERSHIP RENEWAL

   
Members       with lifetime       membership      VOICE credits         $125(+$50 on-site or after 03/15/11)
   
Non-Members:      VOICE credits      $150 (+$50 on-site or after 03/15/11)
   
Nuclear       Medicine       Students      FREE with letter of verification from program director
   
Attendees:

     AMA credits   $200 (+$50 on-site or after 3/15/11)

     AMA CREDITS ARE TENTATIVE-REFUND WILL BE GIVEN IF      NOT PROVIDED

   


Questions? Email us at
member@alabamanucmed.org or djaworowski88@gmail.com

    You will next be taken to the Payment screen.