Minnesota Society of Radiologic Technologists - Member Recognition Submission Form

Minnesota Society of Radiologic Technologists

May 22, 2013

Member Recognition Submission Form

The MSRT is proud to share in its members' achievements throughout the year. If you would like your professional recognition, award and/or promotion posted on the MSRT website, please foward all the pertinent information including name, address and phone number, place of employment and award description using the online form below. Be sure to complete all the required information prior to submittiing. After submitting your information in the form below, the next page will allow to upload an image of yourself or the presentation.

Upon approval, your posting will made viewable on the web site.

Fill in the fields below. Form fields in RED are REQUIRED. Click on ADD Listing to enter a new listing. On the next page you will be prompted to UPLOAD your photo! After your listing and photo has been approved, it will be displayed on our website! Check back in a few days to view your listing!
Technologist to be Recognized Information
First Name:
Last Name:
MSRT Member:
Address:
City:
State:
Zip Code:
Place of Employment Information
Employment Position/Title:
Place of Employment:
Employment Address:
Employment City:
Employment State:
Employment Zip Code:
Recognition Information
Description: of Recognition / Award / Promotion
Photo Caption: (255 characters or less)
Submitter Contact Information
Submitter First Name:
Submitter Last Name:
Submitter Position/Title:
Submitter MSRT Member:
Submitter Address:
Submitter City:
Submitter State:
Submitter Zip Code:
Contact Phone:
Contact Email Address:
AFTER you have added this listing, UPLOAD your photo on the next screen.

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