1 Start 2 Disclosure of Financial Relationships 3 Disclosure of Financial Relationships 4 Investigational Use 5 Permission to Record 6 Content Validation 7 Complete Thank you for agreeing to participate in this year's Society of Pediatric Radiology Course in Cardiac MRI!Please complete all requested fields to the fullest extent possible. In order for your submission to be saved, you must complete all sections of this form.Please contact Jade Freeman-Martinez, CHCO CME Coordinator, at [email protected] if you have any questions or if you need to make a change to your completed form. First Name * Last Name * Degree(s)/Designation(s) Job Title * Main Institution or Hospital Affiliation (No acronyms please) * Main Institution or Hospital Affiliation Location (City, State/Country) Preferred Email Assistant's Name Assistant's Email Please select the role(s) in the Course(s) in which you will participate: * Basic Course - Speaker Basic Course - Moderator Advanced Course - Speaker Advanced Course - Moderator Leave this field blank
