CMIA Request to Attend Conquest Imaging Class



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Request to Attend conquest imaging class

Conquest Imaging is providing the CMIA membership with one FREE seat in all their training classes through 2012. To attend: First go to the Conquest Imaging web site class schedule to select a class and date you want to attend (with two (2) alternates). Second complete the simple CMIA application form (below) & email it to treasure@cmia.org Conquest Imaging will notify you if you are selected to attend. If there are multiple requests for a class and date Conquest Imaging will select the attendee. You must be a current member of the CMIA. Please make sure you can attend the class prior to applying so as to not deprive another member of taking the class. Transportation, meals and lodging are your responsibility. Registration is not transferable without the approval of the Board.

		all items are required
	First Name:
	Last Name:
	CMIA Chapter:
	CMIA Member Since:
	Facility:
	Website:
	Position Title:
	Phone:
	E-Mail:

	First Choice & Date
	Second Choice & Date
	Third Choice & Date

Terms: Please fill out all fields requested above. Applications submitted incomplete will not be considered. CMIA Scholarships for Conquest Imaging Ultrasound training classes are only available to Directors, Managers, and Clinical/Biomedical Engineers employed in the hospital industry. No Vendors or Corporate Members may benefit from this scholarship. Please allow up to 2 weeks for your application to be processed. If you should have any questions, please contact treasure@cmia.org. Thank You!