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ORANJ Application for Newly Certified Tumor Registrar Award
Page 1 Form
ORANJ is offering an award to the amount of the Certified Tumor Registrar’s examination fee to a newly Certified ORANJ member. If your employer had paid the reimbursement fee, please do NOT apply. In addition ORANJ would like to recognize the newly CTR’s therefore please forward me your name, hospital affiliation; date exam passed and copy of your CTR certificate.
This award and recognition will be performed at the installation and award ceremony that will be held on Friday October 14th at the ORANJ annual meeting.
The deadline is September 23, 2011.
1.
Please complete the following information as they apply:
First Name
Last Name
School/Facility
Address
City
State
Postal Code
Email Address
Work Phone
Home Phone
2.
Examination Date
3.
CTR Number
4.
ORANJ (TRANJ) member since?
5.
Please list any ORANJ (TRANJ) activities, offices or committees and the year in which you volunteered or participated.
6.
Will your employer pay for this registration fee?
I attest my employer will not pay for this registration fee.