2023 ILEAD Presentation Entry Form – Welcome to TXSRT.ORG

Title of Presentation *

Name of Student Speaker *

Email Address *

Mailing Address *

City/State/Zip *

Primary Phone with Area Code *

Alternate Phone with Area Code

Please read and acknowledge each statement. Be advised failure to acknowledge all applicable statements may result in an incomplete application *

I acknowledge that I am currently enrolled in an accredited medical imaging or radiation therapy program.
I acknowledge I am not currently registered in any primary medical imaging or radiation therapy modality.
I acknowledge I will be subject to disqualification as well as my submission if the above acknowledge are verified as inaccurate or not compliant with qualifying standards.

TSRT Membership ID Number *

TSRT Membership Expiration Date *

Name of School *

Name of Program Director *

Program Director's Email *

Upload Outline and Objectives *

Click or drag files to this area to upload. You can upload up to 2 files.

Upload an outline in Microsoft Word only format with three (3) objectives of the presentation.

Upload Letter of Verification *

Click or drag a file to this area to upload.

The Program Director must complete and sign the letter of verification for your student status. Please note the same letter of verification may be submitted under each applicable competition. The attached letter from your Program Director must be on college/school letterhead and the date should not exceed 2/1/2020.

I attest that I have read the above rules and regulations for the iLead Leadership Presentation Competition. I understand and agree to abide by these rules and regulations governing the iLead Leadership Presentation Competition. *

I Agree

Phone