Radiation Safety Officer Registration Form - Applied Health Physics, LLC

Cost: $895.00 October 12 – 14, 2021

When registering for a class, please make sure you fill out the form in its entirety or it will not process.October

Full Name

Email Address

Company

Street Address

City

State

Zip Code

Phone Number

Date of Class

P.O.#

Use Of Radiation

Name on Credit Card

Credit Card Number

Expiration Date

CID Code on Back

Refunds will be issued for all cancellations except those made within 5 business days of the course (for which a 50% refund will be given).
“No shows” are subject to the full fee. Substitutions may be made at any time prior to the class.