Clone of November 2025 VPMA Rad Tech Course Registration

Thank you for your interest in the Radiologic Technologist Certification Course & Examination brought to you by the Virginia Podiatric Medical Association. The course will be held on Saturday, April 18 from 9:00 AM - 1:30 PM. The exam will be held on Sunday, April 19 from 9:00 AM - 11:00 AM.

Please complete the form below to register for this event.

Zoom details and course material will be emailed to you. Please ensure we have the correct email address for you and make sure smcconnell@ramdocs.org is added to your address book to prevent confirmation material going to your Spam box.

Attendee Full Name*

First NameLast Name

Practice Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Attendee Email - you MUST be able to access this email address on Sunday for to receive the Exam link*

example@example.com

Attendee Cell Phone Number*

I would like to add another participant*

YesNo

Attendee 2 Full Name*

First NameLast Name

Practice Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Attendee Email - you MUST be able to access this email address on Sunday for to receive the Exam list*

example@example.com

Attendee Cell Phone Number*

I would like to add another participant*

YesNo

Attendee 3 Full Name*

First NameLast Name

Practice Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Attendee Email - you MUST be able to access this email address on Sunday for to receive the Exam list*

example@example.com

Attendee Cell Phone Number*

Number of people registering for the course: (Please make sure payment reflects the correct # of attendees)*

123

My Products*

Radiologic Technologist Certification Course & ExaminationQuantity selected must match the number of registrants.

$375.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Radiologic Technologist Certification Course & Examination

Attendee Information

Additional Participants