Post on 26-Jan-2017
RegiSTRaTion FoRm
ThRee eaSy WayS To RegiSTeR1 ONLiNe: www.asnc.org/asnc2012
2 FAx:* (301) 215 - 7113 Credit card payments only
3 MAiL:* ASNC 4340 East West Highway Suite 1120 Bethesda, MD 20814-4578
NAME W/DEgrEE(S)
INStItutIoN
ADDrESS
CIty/StAtE/ZIp/CouNtry
pHoNE/FAx/E-MAIl
meThod oF PaymenT CHECk AMEx MAStErCArD VISA
CArD # Exp. DAtE CVC/SECurIty CoDE
prINt NAME oN CArD SIgNAturE
Make check payable to ASNC in U.S. funds
Join noW! Visit aSnC’s member Center at www.asnc.org and complete the membership application or call (301) 215-7575.
eaRly BiRd RegiSTRaTion (By July 1, 2012)
PRe-RegiSTRaTion (July 2 – august 17, 2012)
SPeCial oFFeRS (Select Syllabus information below.) member non-member member non-member
ASNC2012 PLuS Board Exam prep Ancillary program $865 $1095 $965 $1195
ASNC2012 PLuS Nuclear Cardiology for the Working technologist program $425 $500 $525 $600
aSnC2012 RegiSTRaTion
physician $535 $785 $635 $885
technologist $295 $395 $345 $445
Nurse $295 $395 $345 $445
practice Administrator $295 $395 $345 $445
Abstract presenter $295 $395 $345 $445
Abstract presenter (Fellow-in-training w/verification letter) $0 $0 $0 $0
other (please check appropriate category) $295 $395 $345 $445
Scientist (non-MD or equivalent) Industry (non-MDs) physician-in-training (Affiliate) physician (Active Duty Military with Documentation) other
anCillaRy PRogRamS (Select Syllabus information below.)
Board Exam preparation Course (9/4-9/6) $765 $995 $865 $1095
Nuclear Cardiology for the Working technologist (9/5-9/6) $325 $400 $425 $500
BoaRd exam PRePaRaTion aTTendeeS:
Syllabus Selection: please select one syllabus option. Note that all Board exam Preparation registrants will have access to the electronic syllabus.
Electronic Syllabus: $0 Black-and-White printed Syllabus: $60 Color printed Syllabus: $225
totAl:
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nuCleaR CaRdiology FoR The WoRking TeChnologiST aTTendeeS:
Syllabus Selection: please select one syllabus option. Note that all Working Technologist registrants will have access to the electronic syllabus.
Electronic Syllabus: $0 Black-and-White printed Syllabus: $30 Color printed Syllabus: $135
totAl:
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SuBToTal $
aSnC oFF-SiTe eVenT BalTimoRe oRioleS VS. neW yoRk yankeeS aT Camden yaRdSTicket price includes dinner at Camden yards and ticket to the game
Saturday September 8, 2012, 5:30 p.m. –10:30 p.m. $75 per ticket ———— Number of ticketstotAl:
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ToTal PaymenT $
aSnC2012 meeTing on demand
this is your opportunity to have all of the valuable meeting content available to you after the meeting has ended at 25% off the on-site purchase price. $75
totAl:
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SuBToTal $
The 17th annual Scientific Session of the american Society of nuclear Cardiology
(Must be a current member to qualify for member pricing — check the box below and join today for no additional charge.)
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AAAAAAAAASSSSSNCNNNNCCCCBALTIMORE20122012AAAAAASSSSSSSNNNNNNNCCCCCCCCCAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
*An extra fee of $25 will be charged to mail or fax registrations.