Women Radiologists’ Brunch, hosted by WSRS - Washington State Radiological Society

June 4, 2017
10 a.m. to 1:30 p.m.
Salty’s on Alki, Duwamish Room

Name:

First

Last

Credential (MD/DO/PhD/other)

Check as many of the following as apply:

Diagnostic radiologist

Radiation oncologist

Medical physicist

Member-in-Training

If you are a Resident or Fellow please specify where:

Name of practice:

Billing address associated with your credit card:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone:

Area Code

Phone Number

E-mail:

Women Radiologists’ Brunch cost:

Physician - $35

Resident or Fellow - $20

Click the submit button below and you will go directly to a paypal payment screen. You do not need a paypal account to pay by credit or debit card.

If you would prefer to send a check, made payable to WSRS, please click the submit button and then do not fill out the payment information on the next screen.

Mail your check to:

WSRS
Women Radiologists’ Brunch Registration
2001 6^th Ave., Suite 2700
Seattle, WA 98121

Cancellation requests must be received in writing, via email, to: debra@wsrs.org

Full refunds will be provided for cancellations received up to the end of the business day, May 26, 2017. No refunds after May 26, 2017. Thanks for your understanding!

Please verify: