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Ultrasound > Registration > Online Registration

Ultrasound Course Online Registration

         

Course Titles Desired:
(Use Control Key [Ctrl] to click multiple selections)

Attendance Dates:
Personal Information
Name/Title:
 		Specify Title if Other:

Sonographer -ARDMS#:
 		Physician Speciality:

ASE Membership Number:
 (Physician or Sonographer)		 Current Position:


College/Technical School:
(Please see prerequisites)

Allied Health Experience:
Years
     

Address:
Street Address:
City:
State:
Zip Code:
Daytime Phone:
Fax:
E-mail:


If you have a disability which requires special accommodations, please check here and advise us of your needs at least three weeks prior to arrival.


 
Fees (US dollars):

(Use Control Key [Ctrl] to click multiple selections)

Please mail check to the address at the bottom of the page.
Make checks payable to "Wake Forest University Health Sciences - Ultrasound"
If paying by credit card, please indicate the phone number at which you can be reached so we may take your credit card information over the phone :

Daytime Telephone: (please include area code)
**Registrations can not be guaranteed until payment is received.

     

CENTER for MEDICAL ULTRASOUND
WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NORTH CAROLINA 27157-1039
Telephone: 336-716-4505 or 800-277-7654
Fax: 336-716-2447
E-mail: cmu@wfubmc.edu