Jefferson Musculoskeletal Imaging Division

Please fill out the form below and submit via e-mail OR print the form and mail/fax to:

Education Office, Department of Radiology
Thomas Jefferson University
Suite 780, Main Building
132 South 10th Street
Philadelphia, PA 19107-5244
Fax: (215)923-9452

You will receive a confirmation phone call from the Education Office within 2 – 3 business days.

Name
Degree
Specialty
Institute
Address
City          State   Zip Code
E–mail
Phone     Fax

Early Bird Discounted Price $525 (More than eight weeks before course)
Full Price $575
Discounted Price $450 (Past participants of courses, former fellows)
Staff-in-training $150 (letter from School Director required)

Planned method of payment

Visa MasterCard Amex Check*

Create A WebID

Please enter any 4 numbers that you can easily remember. This will allow you to access your CME certificate via the Internet after you complete a course.

WebID:

Please note:

For security purposes, Thomas Jefferson University will not accept payment information by e-mail form. Upon receipt of this form, a member of the Education Office will contact you via phone to confirm your reservation and to arrange payment.
A $50.00 non-refundable deposit is required to reserve your registration.

* Please make check payable to "Ultrasound Institute - TJU"

Continuing Medical Education

Jefferson Musculoskeletal Imaging Symposium Course Registration Form