Chicago Society of Echocardiography - Registration Form - non-profit, organization, physician, sonographer, echo, cardio, echocardiography, chicago, illinois, IL, learning, images, video, ceu credit, cme credit, quizes

Home

Registration/Dues

Mitraclip valve repair

Membership Registration

To register for membership to Chicago Society of Echocardiography, you can either:

Fill the paper form and mail your check for appropriate payment to the address listed on the form.

Membership Registration Form

Submit below online registration form. After submission of the registration, you will be automatically redirected to pay your membership dues online.

sub_line

Membership Online Registration Form

Name*:

Credentials:

	MD		DO		PhD		RDCS		DRMS		RVT
	Other

Address*:

Email Address*:

Phone*:
( xxx-xxx-xxxx )

Fax:

Hospital Affiliation:

Membership Type:

Please select one below.

Physician CSECHO Membership plus up to 18 hours AMA Category 1 CME
($69/year summer special - regularly $85/year)

Cardiology Fellow CSECHO Membership
($49/year summer special - regularly $60/year)

Sonographer CSECHO Membership plus up to 18 hours SDMS CEUs ($40/year)

Sonographer Student CSECHO Membership ($30/year)

Cardiologists or Sonographers wanting SDMS CME credit must complete one of the following:

License#:
Registration#:
Date of Birth:

Number of years registering:

Please select one below.

1 year

2 years

3 years


	Copyright © 2004-2010 Chicago Society of Echocardiography, All rights reserved.