Tech's Name:

Tech's ARMRIT Certificate number:

Email:

Address

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Phone

Work Phone

Employer

City

State

Equipment Experience

Renewal was due by Dec 16, 2020. Include the following:

1) Three-year Renewal fee (including late fee after Dec 16, 2020 of $400.00)

2) Evidence of at least twenty-four (24) CME credits in MRI Technology performed in 2018, 2019, or 2020.

Proof of CME (24) credits: (choose one): MRI Subjects Only!!!

Already on file:
Will send:

Were you convicted of a felony or misdemeanor since last renewal? YES     NO

If YES, submit details for review.

Please complete the sentence:

*Renewal is mandatory to maintain your Credential & Certification Registry Active status.
**A Certificate and ID Card will not be released until CME evidence is provided.
***Late Fees Apply / Failure to Renew Will Lead to Revocation (see note) after Dec 16, 2020.
****Not Tax Deductible.
***** Consult your Tax Advisor for Tax Deductibility.

Note: Revocation renders your Credential & Certification null & void requiring completion of an application and sitting for the examination. No exceptions!

Or Click Here for a form to fill out and fax to: 561-265-5045
or mail to:
ARMRIT
2444 NW 8th Street
Delray Beach, FL 33445