MSDU Annual Conference Registration
(items with * are required) |
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| Attendee Information |
| ARDMS Registered?*:
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| If Yes ARDMS #: |
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| OR Date of birth: |
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| First Name*: |
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M.I.
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| (First Name to appear on conference badge) |
| Last Name*: |
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| Suffix (Jr, Sr, III....): |
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| Credentials: |
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| Address*: |
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| City*: |
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| State*: |
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Zip*:
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| Phone*: |
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| Email*: |
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| Annual Conference Registration |
*A. Friday Night Live Scanning Instruction:
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Note: Registration is limited. You may only register for one of the topics, however, floating between topics will be allowed after all attendees have received instruction on the topic he/she registered for.
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| *B. Daily Annual Conference Registration:
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***Rate (prior to 3/14/2012)***
Attention Students: In order to receive the discounted student rate, you must be enrolled in a full-time formal education program and a letter from the program director must be sent before your registration will be complete. Mail letter to: Jasmine Podgorski, RDMS, RVT, C/O MSDU, 720 7th St., Farmington, MN, 55024, or fax to Attn: Jasmine Podgorski @ 651-326-1907. |
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*C. Floating is allowed between tracks. However, for planning purposes, please select the educational track you will likely attend the most sessions in. Choose only one.
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How did you hear about this year’s meeting?
(Select one)
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Cancellations/Refunds: All written cancellations postmarked no later than March 14, 2012, will receive a refund less a $50.00 processing fee. No refunds will be made after March 14, 2012. |
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