"*" indicates required fields Saturday, November 5, 2022 7:30am - 6:00pmm South Lake Union Marriott Name* First Last Credentials (MD, DO, etc.) Group/Hospital Preferred PronounsA pronoun is a word that substitutes for a noun; in this case, a word that substitutes for your name. We want to know what to call you! Examples: he, she, they Address Street Address Address Line 2 City State/Province Postal Code PhoneEmail Are you a member of WSRS? Yes No Please indicate which of the following best describes you* Diagnostic radiologist Radiation oncologist Radiology resident/fellow Radiation oncology resident/fellow Medical student Physician or other medical professional (non-radiologist) Other Registration Price* Price: I would like to attend the Radiation Oncology breakout session at 2:30 PM Yes No Food Preferences Vegetarian Vegan Gluten Free Coupon Payment Type* Credit Card Check Check Number Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name AccessibilityWSRS is committed to making this meeting as accessible as possible. Let our office know if you have any requests. Inquiries Contact WSRS Office at 206-956-3621 or email admin@wsrs.org. Δ
