Missouri Society of Radiologic Technologists

Missouri Society of Radiologic Technologists

Display Application

The Deadline is March 13, 2025 at 11:59 PM

Are you a student or a technologist?*

StudentTechnologist

Are you a MoSRT Member?*

YesNo

Was this presentation completed by more than one individual?*

YesNo

How many people participated?

Two (2) PeopleThree (3) PeopleFour (4) PeopleFive (5) People

1st Participant Full Name:*

First NameMILast NameSuffix

1st Participant Academic Credentials:

1st Participant Professional Certification:

1st Participant Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

1st Participant Primary Email Address:*

Confirmation Email

2nd Participant Full Name:*

First NameMILast NameSuffix

2nd Participant Academic Credentials:

2nd Participant Professional Certification:

2nd Participant Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2nd Participant Primary Email Address:*

Confirmation Emailexample@example.com

3rd Participant Full Name:*

First NameMILast NameSuffix

3rd Participant Academic Credentials:

3rd Participant Professional Certification:

3rd Participant Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

3rd Participant Primary Email Address:*

Confirmation Emailexample@example.com

4th Participant Full Name:*

First NameMILast NameSuffix

4th Participant Academic Credentials:

4th Participant Professional Certification:

4th Participant Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

4th Participant Primary Email Address:*

Confirmation Emailexample@example.com

5th Participant Full Name:*

First NameMILast NameSuffix

5th Participant Academic Credentials:

5th Participant Professional Certification:

5th Participant Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

5th Participant Primary Email Address:*

Confirmation Emailexample@example.com

Full Name:*

First NameMILast NameSuffix

Academic Credentials:

Professional Certification:

Home/Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Primary Email Address:*

Confirmation Emailexample@example.com

Employer/School:

Employer/School Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Title of Display:*

Title of Exhibit must EXACTLY match the registration form.

*** Important! ***

Your file name must be: MoSRT 2025

Examples:

If your UDI (randomly generated below) is 999, your file name will be: 999 MoSRT 2025

If your UDI (randomly generated below) is 000, your file name will be: 000 MoSRT 2025

Failure to properly name your file could result in disqualification from the competition.

Unique Display Identifier (UDI):

UDI Verification*

Upload a PDF version of your display.*

Browse Files

Your file name should be: UDI MoSRT 2025

By checking the box below:

I understand that it is my responsibility to name my file name to "UDI MoSRT 2025" and that I will change UDI to match the UDI number that was assigned to me above. If I fail to name my file appropriately then I understand that I may be disqualified from the competition.