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		JOIN MRMS! If you would like to join MRMS, please fill out a request for an application. We will respond to your request as soon as we can.

Join us for our 19th Annual MRMS Educational Conference
April 24-28, 2010
“Building the Foundation of Excellent Imaging”

at Omni La Mansion del Rio, San Antonio, Texas
www.OmniHotels.com

REGISTRATION FORM

First Name:
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Registration Fees:
Number of Guests:	@ $75 per Guest
Total Fees:
Attend & Become an MRMS member! All non-MRMS members who attend 2010 Conference at the non-member rate will receive a free, 1 year membership to MRMS, a $125 value. Conference Cancellation Cancellation of your conference registration must be received in writing to: Lori Nicolay, MR/CT Supervisor, MRMS Secretary, St. Luke’s Imaging Center, 4321 Washington Suite 1400, Kansas City, Missouri 64111 by April 2, 2010. If you cannot attend, you may send a substitute. Please notify MRMS of your substitute’s name.
Check this box if the above information is the same as your credit card billing address information. If you do not check this box, then you will be required to fill in your billing information on the next page.

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