Refund Policy:
Before Sept. 1, 2010: Amount refunded minus $5.00
After Sept. 1, 2010: Amount refunded minus $25.00
After Oct. 31, 2010: No refunds
JEM Educational Services
Presents
The 2nd Annual X-ray Technician Education Conference
Saturday, November 6, 2010
8:00AM - 5:00PM
8.0 CE
7:30 AM to 7:55 AM - Registration
8:00 AM - Session Begins
5:00 PM - Session Ends
Registration Form
Name:
______________________________________ , __________________________________________
Contact Info:
___________________________________________________________________________
Ph:
________________________________
e-mail:
____________________________________________
Please check one
:
_____X-ray Technician _____XT Student (Current XT School ___________________) _____Vendor
Early Registration:
(Before 10/20/10)
Registration: (After 10/20/10)
On-Site Registration:
(Based on space availability)
Students:
Check / Money Order Enclosed:
95.00
110.00
125.00
35.00
$
$
$
$
Make Payment to:
Mail to:
JEM Educational Services
271 Ott Street, Suite 24
Corona, CA 92882
Credit / Debit Card: AMEX MC Visa Card #
Name on Card: Exp. Date: / /
Billing Address:
Signature:
Street City State Zip
Street City State Zip
Last First
(You can also call JEM Educational Services for credit card payments over the phone (951) 737-8433)
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