2022 Virtual FALL Symposium Registration Form

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Complete this form to attend the virtual NCUS Fall Symposium.

Email *

First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Date of Birth (mm/dd/year) *

Cell Phone Number *

ARDMS #

SDMS #

CCI #

ARRT #

I work in the following specialties *

ABD

OB/GYN

Adult Cardiac

Pediatric Cardiac

Vascular

Education

Student

Required

Employer Name (if applicable)

Your Position/Title

Employer Mailing Address

City/State/Zip Code

Work Phone Number

If you are a student, please provide name of college.

I will be attending the virtual Fall Symposium: *

Sonographer $175

Student $50 *Will need letter from Program Director.

Required

Thank you for registering for the NCUS Virtual Fall Symposium. Please return to the NCUS webpage to submit your online registration payment. You may also mail a check or pay by telephone, if you prefer. Please contact the NCUS Central Office at ncus.centraloffice@gmail.com.

A copy of your responses will be emailed to the address you provided.

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