JEM EDUCATIONAL SERVICES
SESSION REGISTRATION FORM 2010
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Saturday, July 24, 2010
8:30 AM - 5:00 PM
Make Check/Money Order Payable To:
JEM Educational Services
271 Ott Street, Suite 24
Corona, CA 92882
(951) 737-8433
PLEASE PRINT
Name: _______________________________________________________________
Last First MI
Address: _____________________________________________________________
Street City State Zip
Contact phone: ( )___________________________________________________
E-mail address: ________________________________________________________
Employment: _____Hospital _____Imaging Center _____Women's Center
_____Out Patient Clinic _____Other: _____________________
***Mail this Registration Form to the address listed below***
Sonography
Physics & Instrumentation Review
*Confirmation of session will be phoned or emailed to you.
*Please mail this form with fee*
Payment Enclosed:
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to obtain this form.
_____ $195.00 Early Registration (Before 7/10/10)
_____ $220.00 After 7/10/10
Check, Money Order, Credit Card/Debit Card Accepted
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