34th Annual Duke Radiology Review Course

March 3-9, 2018

Sponsored by Duke University School of Medicine

Office of Continuing Medical Education

Sheraton Imperial Hotel, Research Triangle Park, NC

FIRST Name______LAST Name ______

Please print all information

Degrees______

Address______

City______State______ZIP______

Phone ______Email ______

Conference Registration: Registration is required and the course does fill to capacity. Fees include all continental breakfasts, breaks and lunches.

Conference Materials: In an effort to be more environmentally conscious, we will distribute syllabus electronically. You are encouraged to bring your laptop or electronic device to follow along. All seats are equipped with power strips for your convenience. A paper syllabus will only be provided upon request at a cost of $100. Please mark the appropriate box below.

Conference Registration Fees (per person)

to indicate your choices and write the fee in the FEE Blank.

RegistrationRegistration

On or prior to 2/9/18After 2/9/18

Practicing Radiologist $1,450 $1,525

Military Radiologist / VA Employee $1,000 $1,075

Resident / Fellow $950 $1,025

PRINTED SYLLABUS $100 $100

TOTAL FOR ALL FEES $______

If registering as a Resident/ Fellow: Please provide the name of your current training program/institution including City/State

Resident/Fellow: Please provide current training year

 1st Year 2nd Year 3rd Year 4th YearFellow

Payment information will be completed on the next page.

Registrations without payment will not be accepted. Credit card orders can be faxed to 919-660-1769.

Registrant Name:______

Method of payment: All payments are in US dollars. Accepted payment methods are Credit Card or Check

Credit CardCheck

Checks and Purchase Orders are made payable to:Duke University Conference Services

Duke Radiology Review Course

02 Bryan University Center

Box 90841

Durham, NC27708-0841

Credit Card Payments: please check card type:

American ExpressDiscover MasterCard Visa

Card number______Exp______

Signature______

Name on Card, if different from registrant______

Billing Address, if different from registrant______

City______State______ZIP______

Registrations with credit card payments may be faxed to Duke University Conference Services at 919-660-1769.

Cancellation Policy: A $100 administrative fee will be assessed on all refunds prior to February 16, 2018. After that date no refunds can be made. Notice of cancellation must be received in writing to Debbie Griffin via email at .

Do you have mobility or dietary information on which we should be aware? If so, please list:

Accommodations:

A block of rooms has been reserved at the Sheraton Imperial RTP. Reservations are on a first call, first serve basis. Please make reservations early as the block will sell out.

Hotel reservations may be made online by going to radiology.duke.edu and clicking on the hotel reservation link under Duke Review Course or by calling the Sheraton Imperial RTP at 919-941-5050 and stating that you are participating in the Radiology Review Course.

There are alternate accommodations within walking distance of the hotel. A list of those and their phone numbers can be found at:

Questions?Registration Questions should be directed to Duke University Conference Services by email at or by phone at 919-660-1760 Monday-Friday 8:30am to 4:30pm East Coast Time.

Program Questions should be directed to Debbie Griffin by email at or by phone at 919-684-7228 Monday – Friday 8:30am to 4:30pm East Coast Time.

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