Radiology Technology Pre-Orientation
Registration Form
Permanent Address 
First Name: 
Last Name: 
Address: 
City:  State:  Zip: 
Phone: 

Yes, I will attend the February 17th, 2006 session Time: 1:30 - 3:30 pm

Yes, I will attend the March 7th, 2006 session Time: 1:30 - 3:30 pm

Yes, I will attend the June 14th, 2006session Time: 9:30 - 11:30 am

Yes, I will attend the September 22nd, 2006 session Time: 1:30 - 3:30 pm

Yes, I will attend the October 19th, 2006 session Time: 9:30 - 11:30 am

Yes, I will attend the November 10th, 2006 session Time: 1:30 - 3:30 pm

No, I will not be able to attend a session Please keep my file active with the program

I have changed my major

Note: If we receive no response from you, you will automatically be taken off our mailing list.

Please mail the completed form to:
Blinn College
Radiologic Technology Program
P. O. Box 6030
Bryan, TX 77805