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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.

MRMS Membership application
To join MRMS, please fill out the registration form below and then either click on the submit button for on-line payment by credit card (you will then be directed to our credit card payment page to complete the transaction), or print the application form and mail it with a check to:

Marti Dussliere, RT (R) (MR)
Metro MRI Center
615 Valley View Drive Suite 102
Moline, IL 61265
mad@metromri.com
309 762-7227 phone
309 762-7293 fax

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How did you hear about MRMS:	Internet Colleague Seminar/Meeting Trade Journal MRMS Brochure Other
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.

Please note that application processing time is approximately 5 business days. You will receive a confirming email from MRMS along with an invitation to join our list serve as well as your members only login password.

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