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

2008-2009 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:

Davide Bova, M.D.
Secretary and Treasurer
Chicago Radiological Society
19w074 Avenue Barbizon
Oak Brook, IL 60523

Reservation and meal choice need to be faxed (708-216-8394), phoned (708-216-1084) or emailed (lschome@lumc.edu) to Linda Schomer by the Friday of the week before each meeting date.

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