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Leading Edge Conference Registration Form

All fields are required.

Name:
Address:
City:
State:
Zip or Postal Code:
Country:
Telephone:
Fax:
E-mail:

Create A WebID

If you are a physician, please enter the last 4 digits of your Social Security Number. This will allow you to access your CME certificate via the Internet after you complete a course.

All other registrants, your certificate will be available for pickup on-site following your last scheduled day of attendance at the conference.

WebID:

What is your profession?

Physician: Specialty
Fellow
Resident
Sonographer
RT
RN
RVT
Other:

I want to subscribe to the JUREI Education Newsletter


How did you hear about JUREI?:

Colleague/Friend
Attended Previous Courses/Leading Edge
Mailing/Brochure
Referring Website      * web address (URL) of the referring website
Internet Search      * name of the search engine used to find JUREI (e.g. yahoo, google...)
Journal     

  * other journal's name


CONFERENCE:

Please indicate the date(s) you want to attend the Leading Edge in Diagnostic Ultrasound Conference.

Tuesday, May 19, 2009 (select only one)
Track:

Wednesday, May 20, 2009 (select only one)
Track:

Thursday, May 21, 2009 (select only one)
Track:

Friday, May 22, 2009 (select only one)
Track:

Registration Fees
Physicians
Fetal Nuchal Translucency   $350
  Before
4/17		 After
4/17		  
1 Day - Friday only (Vasc. or Peds)

$250

 $295
1 Day - T, W or Th $395 $425
2 Days $595 $625
3 Days $775 $800
Full Conference $850 $900
Fellows/Residents/Allied Health Professionals
Fetal Nuchal Translucency   $300
  Before
4/17		 After
4/17		  
1 Day - Friday only (Vasc. or Peds) $195 $225
1 Day - T, W or Th $295 $325
2 Days $490 $525
3 Days $675 $700
Full Conference $750 $800

Special Code:   optional

Payment method:

Check

  • If paying by check, please mail check to the address at the bottom of this page. Make checks payable to "Ultrasound Institute-TJU."

Credit card (AMEX, MC, or VISA)

  • 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 (please include area code):

Thank you for registering for the Leading Edge Conference.  Your registration will be complete once full payment is received.

Cancellation / Refund Policy:
Payment for registration must be made in U.S. funds. The registration fee, less an administrative charge of $100, is refundable if written notification of cancellation is received prior to April 17, 2009.  After that time refunds are not possible, but your payment less the administrative charge may be credited to a future course for use within one calendar year. Payment can be made by check, traveler's checks or credit card (American Express, MasterCard, or VISA). Foreign payments must be made by a draft on a United States bank.

Payment may be sent to the following address:
 Radiology CME Program Manager, Ultrasound Institute
780 Main Building
Thomas Jefferson University Hospital
132 South 10th Street
Philadelphia, PA 19107-5244

Questions?
Contact us at (215) 955-8533 or Toll Free 1-888-390-5051 (USA only) or Fax (215) 923-9452 or e-mail (jurei@mail.tju.edu)


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