CHICAGO RADIOLOGICAL SOCIETY

A DIVISION OF ILLINOIS RADIOLOGICAL SOCIETY

475 S. Frontage Road, Suite 101 • Burr Ridge, Illinois 60527-6282

Ph: 630-323-5344 • Fax: 630-323-6989

Email: info@chi-rad-soc.org • Web Site: www.chi-rad-soc.org

CHICAGO RADIOLOGICAL SOCIETY

2007-2008 Season Dinner Ticket Order Form

Name: _________________________________________________________________________

Institution:_____________________________________________________________________

Address:_______________________________________________________________________

_______________________________________________________________________________                                                                                                                                            

Telephone:_____________________________________________________________________

Number of season tickets requested:_______________________________________

                                                                       (@ $200 per season ticket)

                                                Total Remitted: $_____________

Please send completed season ticket form and remittance payable to “Chicago Radiological Society” to:

John F. Hibbeln, M.D.
Department of Diagnostic Radiology
Rush University Medical Center
1653 West Congress Parkway
Chicago, IL 60612

Reservation and meal choice need to be faxed (312-563-4122), phoned (312-563-4276) or emailed (ETorres@RushRadiology.org) to Erika Torres by the Wednesday of the week before each meeting date.

Season tickets will also be available for purchase at the October 18, 2007 meeting.