Course Registration

Course Registration

ASSR Hands-On Image-Guided Spine Interventions Course
October 22, 23, 24th, 2010
Baltimore, MD

Please complete this form in its entirety and print it out.


*Required


LUNCH


REGISTRATION FEES






*To qualify for the ASSR Member Discount or ASNR Member Discount, you must be a member or have submitted your membership application PRIOR to registering for this course. To apply for ASSR membership, go to: http://theassr.org/join-assr. To apply for ASNR membership, go to: http://www.asnr.org/asnr/brochure/


PAYMENT

Total Amount:
Date Mailed:

We are sorry, but at this time, we cannot accept credit card payments.

Please make checks payable to: University of Pittsburgh Dept. of Radiology

Mail with completed form to:

Walter S. Bartynski, MD
200 Lothrop St. D-132
Pittsburgh, PA 15213

For additional Information:

Kasey Nowalk, Education Coordinator
Telephone: 617-955-3737