Change of Address

To have your mailing address for Board correspondence changed complete and submit the form below.

To: The Secretary       Medical Radiation Technologists Board Please change my mailing and/or register address for Board correspondence. * fields are required

Registration Number *

Full Name *

Current Mailing Address

New Mailing Address

Current Register Address

New Register Address

Contact Phone Number (Daytime/Mobile)

Fax Number

Email Address*

Date of Birth (for verification)*