Registration for SEATTLE 2009

 

The way this works - Fill out this form and when you click on the "submit button" on the bottom
it will send your information to  Frances Perdue R. EEG T.
then a new page will open and give you 2 options of payment _

  1. You will get an address to "snail mail" your payment
    or

  2. You will have the option to "pay online" with PayPal

If you would like to become a member, please continue to the

bottom of this form and complete the Membership information

Any questions can be sent to Frances Perdue R.EEG T.

 If printing and mailing your form: Please Print Clearly

First Name       Last Name  

Credentials
Address:
City: State         Postal Code:        
Home Phone Number      Work Phone Number:
Our Website is our main source of communication with our members.
 It is updated monthly and includes WSET Newsletter, Meeting information, Technical tips, Yellow Pages, Job postings and much more. PLEASE INCLUDE YOUR EMAIL ADDRESS
Main E-mail:    
                        Please Print Clearly if printing and mailing your form
Employer
Address:
City: State Postal Code:
Years of Experience in Electroneurodiagnostics 

 

     Please check the following for WSET    NON-MEMBER  MEMBER STUDENT --Membership Form at bottom of form

     WEDNESDAY  2/18   Course Session

choose one:                                                Non Member   Member    Student

 EEG                                8:00AM-4:30 PM           $135.00           $95.00          $65.00

 IOM Basic                  8:00AM-4:30 PM           $135.00           $95.00          $65.00

 PSG/Sleep Basic     8:00AM-4:30PM            $135.00           $95.00          $65.00

Wednesday Evening Session-(Included in price of Wednesday registration, if attending all three days)

Choose one:

 EP Review             5:00PM-7:00 PM           $65.00             $45.00          $20.00

 EEG Review         5:00PM-7:00 PM           $65.00             $45.00          $20.00

 PSG Review          5:00PM-7:00 PM           $65.00             $45.00          $20.00

                                                                 Wednesday Total    

Thursday 2/19  Course Session     

Choose one:                                              Non Member      Member        Student

EEG                                     8:00AM-4:30 PM           $135.00           $95.00          $65.00      

 IOM Advanced           8:00AM-4:30 PM           $135.00           $95.00          $65.00     

 PSG/Advanced              8:00AM-4:30 PM            $135.00          $95.00           $65.00

Join us for our Social Event! The fee is $20.00 if you attend at least 2 days of the conference.

Attending: YES     NO   .  You may also bring guests for an additional fee of $20.00 per Guest:  Will you be bringing additional guests? if YES    How many?   Additional Cost .

                                                                                    Thursday Total 

Friday 2/20  Scientific  Session

                                                                                                    Non Member   Member            Student

 Scientific Session          8:00AM-4:30 PM           $135.00              $95.00          $65.00   

                                                                                           Friday Total 

 Total Registration Fees                

 THIS IS THE AMOUNT PAYABLE TO WSET FOR YOUR REGISTRATION Only!
                                                      Continue Form to become a Member
I am a NEW MEMBER, I request a "Certificate" suitable for framing & wallet size membership card.  YES   NO 
I am a RENEWAL MEMBER, I request a "current wallet size membership card", YES    NO 
Active Membership (Dues $45.00 US)   NEW    RENEW 
Associate/*Student (Dues 20.00 US)    NEW    RENEW  
I am a NEW Student MEMBER, I request a "Certificate" suitable for framing, YES     NO  
Name of school 
Date you began program 
12 month program  18 month program    24 month program    
Other 
All students MUST INCLUDE a letter of current enrollment from your school/program director.
Write down this information so you will have it when you mail  your letter to
 Katie Clark MS,R.EEG/PSG T. 1658 Sudden Valley Bellingham, WA 98229
Please e-mail any questions to Suzette Izac R.EEG T. MEMBERSHIP CHAIR
 
Program directors name  
& email address 
I have read the above and agree to the terms Yes    No 
Do you plan to pay by - snail mail?   - online PayPal?    (this information will help Katie)
Date

Comments

If you signed up for membership please remember to add to your total

Total registration:   Total Payment including Membership

Please make sure all information is correct before you hit submit


Once you click on the submit button you will see a confirmation that your membership has been mailed, please scroll up and pay using PayPal.

Attendance or Participating in any course study does not guarantee that you will pass your Boards,

 WSET is offering courses for Education purposes only.

WSET 2008

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