US Oncology Peer Review Service Registration Form

Linac being registered
*Serial number:    
*Make:    
*Model:    

*Institution:     RTF no:   or IROC no: if available  
*Institution address:   if different Billing address:
*City:   City:
*State:   State:
*Zip:   Zip:
*Contact physicist first name:     Billing contact first name:
*Contact physicist last name:     Billing contact last name:
*Contact physicist e-mail:   Billing contact e-maill:
*Contact physicist phone:   Billing contact phone: *Contact physicist phone: ?Billing contact phone:

*Package desired:


 
Afterloader manufacturer: Source manufacturer:
Afterloader model: Source model:
Afterloader S/N:    

You will receive an invoice for your order.

Important details
The term is for 3 years, ending 12/31/2017.
Any result outside of criteria (phantom or OSLD check) will necessitate a repeat. The cost of this repeat is not included in the package price.
For questions, please contact Stephen Kry, Ph.D., E-mail to: Sfkry@MDAnderson.org