Radiological Training Registration Form
To register, complete information and Fax or Mail to:
Suntrac Services,
Inc.
1818 East Main Street
League City, Tx 77573
(281) 338-2133
Fax # (281) 338-2136
---------------------------------Registration Form-------------------------------
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1.____________ ___-___-___ ____________.___ ___/___/___ 2.____________ ___-___-___ ____________.___ ___/___/___ 3.____________ ___-___-___ ____________.___ ___/___/___ 4.____________ ___-___-___ ____________.___ ___/___/___ 5.____________ ___-___-___ ____________.___ ___/___/___ Company Name: _____________________________
Phone#: ____________________________Fax#:
______________________________
If a registrant is unable to attend a course, a substitute may attend in the place of the original registrant. However, if a registrant is unable to attend and no substitute is made, a course cancellation must be made 14 days prior to scheduled course date. Cancellations made less than 14 days prior to course date are subject to be charged a $100.00 cancellation fee per registrant. Course fees are non-refundable for registrants failing to cancel prior to the start of the course. |
Payments Due 14 Days Prior to Class Date
Check#_______ Total Amount Paid $________
Credit Card #_________________________ Exp Date: ________
Credit Card Verification Code: __________
P.O.#____________________________________
Please send in this registration form to participate in the training
class. You will receive a confirmation
by either e-mail or phone. If you do not hear from us within
3 days, please give our office a call.
SUNTRAC Services, Inc., 1818 East Main Street, League City, TX. 77573 (281) 338-2133