MSDU Membership Form (items with * are required)
New memberships and renewals discounted until 1/2/2012.
New Membership:
Renew Existing Membership:
Membership Type*: Sonographer - $30 Physician - $40 Student - $10 Commercial - Fees Waived Please Choose
Your Information
First Name*:
Last Name*:
Address*:
City*:
State*:		Zip*:
Email*:
Phone*:	xxx-xxx-xxxx
Employer Information
Employer:
Address:
City:
State:		Zip:
Current Student*:	No Yes Please Choose
If Yes:
Current School*:
Graduation Date*:
ARDMS Registered?*: No Yes Please Choose
If Yes:	RDMS RDCS RVT RPVI
ARDMS #:
Other Credentials:
Currently practicing, which specialty(ies)/area(s), check all that apply:
Abdomen Breast Adult Cardiac OB/Gyn Neurosonology Pediatric Cardiac Vascular Veterinary Fetal Cardiac