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SSET MEMBERSHIP FORM 2023
Thank you for your interest in
SSET: Southern Chapter of ASET
- The NeuroDiagnostic Society
First Name
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Last Name
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Credentials
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Do you have formal education in NDT?
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Formal Education (institution and degree)
Years in END field
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Email Address
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Preferred Phone
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Title
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Employer
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Department
Employer Address
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City
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State
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Zip Code
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Preferred Address
City
State
Zip Code
Are you interested in running for SSET Office?
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Yes
No
Membership Type (CHOOSE ONE)
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Active Member (renewal) $30
New Member $30
Student Member $10
International Member
student/trainee: provide supervisor or program director FULL NAME
student/trainee: provide supervisor or program director EMAIL address
Suggestions for Annual Meeting Topics (yes we do read these)
Signature (DRAG CURSOR TO DRAW SIGNATURE)
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