MRI Fellowship Registration
Please fill this form and complete payment at least two weeks prior to arriving for a fellowship so that we may tailor course content to your needs. You can use the Paypal button directly above or below this form to complete your payment.
Email address *
What is the scheduled start-date of your fellowship? *
Please note that you need to first speak with Dr. Sage to agree on a mutually acceptable date.
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What is your name? *
Your answer
What is the name of your clinic or university? *
Your answer
What are your credentials? *
Required
What best describes your veterinary practice? *
What best describes your daily interaction with MRI studies? *
Below is a list of topics that we generally cover. Please check any that you have a specific interest in or need to improve on. *
Required
What specific goals do you want to achieve at the completion of this course? *
Your answer
Do you have any particular areas of interest that we should plan to cover? *
Your answer
Is there any other information we can provide for you about Georgetown, activities, hotels, restaurants, airport transportation, weather, etc? *
Your answer
I agree to use the Paypal button below to complete payment for this fellowship at least two weeks prior to my arrival. *
Required
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