Canadian Association of Medical Radiation Technologists | Media/Multimedia Exhibit

Media/Multimedia Exhibit - Entry Form

Your Full Name *

CAMRT Reg. #

Submission Category *

MRT Exhibit

Student Exhibit

Contact Information

Address

City

Province

Postal Code

Home Telephone

Work Telephone

Email *

Please complete one of the following sections: MRT or Student

MRT Submission

Employment Title/Position

Name of Employer

STUDENT Submission

Education Program (Discipline)

School Name

Alternate Contact

Please provide the name/title of an alternative contact (i.e., supervisor, instructor, colleague) in the event that we have difficulty reaching you:

Name

Telephone

Your Exhibit

Title of Exhibit

Co-Authors

Permission

Exhibit submissions may be showcased on the CAMRT website. I give permission to the CAMRT to post my submission on the website (camrt.ca)

Yes

Presenting Exhibit

I am interested in presenting my exhibit on CAMRT’s Communities of Practice.

Yes

Attachment

Please wait for confirmation page before clicking “Back” button or closing your browser as this will cancel your upload. If “upload fails” after several attempts please email the files to Phyllis Williams

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Media/Multimedia Exhibit – Entry Form

Contact Information

MRT Submission

STUDENT Submission

Alternate Contact

Your Exhibit