Arizona Society of Echocardiography Membership Application Name: _____________________________________ Title: ________________________  Company Name: _______________________________________________________      Business address: _______________________________________________________ _______________________________________________________________________ Phone:  ______________ Fax:  ___________ E-mail:  ________________ Home address: __________________________________________________________ _______________________________________________________________________ Phone:  ______________ Fax:  ___________ E-mail: ________________   Membership Type:   Physician                                                                $ 50 ___                                 Student, sonographer, healthcare professional            $ 35 ___   Please make check payable and mail to:  Arizona Society of Echocardiography 13485 N 103rd Way, Scottsdale, AZ 85260