member registration

THREE RIVERS ECHO SOCIETY

Membership/Registration

Please Complete Form and Follow Instructions at Bottom of page.

Step 1: Print This form if mailing payment (use Print Button on your browser)

Step 2: Press the "Submit Form" Button (Emails Administration)

Step 3: Mail Printed Form with payment to: Three Rivers Echo Society, PO Box 62, Vandergrift, PA 15690

Make Checks Payable to: "Three Rivers Echo Society"

Registration is once per calendar year regardless of when you join. (January to January)

First Name		Last Name
Suffix (MD, RDCS, etc.
Where you work	Above information is what will appear on your name tag
Mailing Address
City		State
Zip/Postal Code		Work Phone
Home Phone			Do you plan to attend next meeting? yes no
E-mail
	Please indicate "none" in box if you do not have an email

Yearly Fee	Check One	Membership Category:
$75.00		Physician
$35.00		Sonographer
$35.00		Fellow (Will be verified)
$35.00		Nurse
$15.00		Student Sonographer (Will be verified)