Create Account
Below, please enter the requested information. Also, please provide an email address so we can send you your login information. When you've finished, click the [Create Account] button at the bottom of this page.
Required fields are indicated by a red asterisk(
*
) and
bold lettering
.
Facility Information
The facility is located:
*
Select One
In the United States or Canada
Outside of the United States/Canada
Organization Legal Business Name:
*
Federal Tax ID: xx-xxxxxxx
*
Have a Canadian Business Number?
We only need the 9 digits of your Business Number that identifies your business; we don't need the six digits that identify your tax account. Please enter those 9 digits in this format: 12-3456789.
Use a 2-character abbreviation of your country, and any code used to uniquely identify your organization, such as a tax id. IAC will not share your information with any public or private organization.
Phone Number: xxx-xxx-xxxx
*
Street Address:
*
Street Address 2:
City:
*
Province/State/Region:
*
AL -- Alabama
AK -- Alaska
AB -- Alberta
AS -- American Samoa
AZ -- Arizona
AR -- Arkansas
AE -- Armed Forces
AA -- Armed Forces Americas
AP -- Armed Forces Pacific
BC -- British Columbia
CA -- California
CO -- Colorado
CT -- Connecticut
DE -- Delaware
DC -- District of Columbia
FM -- Federated States of Micronesia
FL -- Florida
GA -- Georgia
GU -- Guam
HI -- Hawaii
ID -- Idaho
IL -- Illinois
IN -- Indiana
IA -- Iowa
KS -- Kansas
KY -- Kentucky
LA -- Louisiana
ME -- Maine
MB -- Manitoba
MH -- Marshall Islands
MD -- Maryland
MA -- Massachusetts
MI -- Michigan
MN -- Minnesota
MS -- Mississippi
MO -- Missouri
MT -- Montana
NE -- Nebraska
NV -- Nevada
NB -- New Brunswick
NH -- New Hampshire
NJ -- New Jersey
NM -- New Mexico
NY -- New York
NL -- Newfoundland
NC -- North Carolina
ND -- North Dakota
MP -- Northern Mariana Islands
NT -- Northwest Territories
NS -- Nova Scotia
NU -- Nunavat
OH -- Ohio
OK -- Oklahoma
ON -- Ontario
OR -- Oregon
PW -- Palau
PA -- Pennsylvania
PE -- Prince Edward Island
PR -- Puerto Rico
QC -- Quebec
RI -- Rhode Island
SK -- Saskatchewan
SC -- South Carolina
SD -- South Dakota
TN -- Tennessee
TX -- Texas
UT -- Utah
VT -- Vermont
VI -- Virgin Islands
VA -- Virginia
WA -- Washington
WV -- West Virginia
WI -- Wisconsin
WY -- Wyoming
YT -- Yukon Territory
Postal Code:
*
Country:
Testing Modality
Which testing modalities is your facility currently applying for?
*
Diagnostic
:
CT
Adult Echocardiography
Pediatric Echocardiography
MRI
Nuclear/PET
Vascular
Dental CT
Interventional
:
Carotid Stenting
Vascular Interventional
Cardiac Electrophysiology
Cardiovascular Catheterization
Email Address
Please enter the address where you'd like us to send your login information and Account ID.
Email Address:
*
After logging into the Online Application using the temporary account User ID and Password you must follow the instructions/link on the main page to create an application administrator for the account. All application administrator/log in information will be sent to the provided email address
The email address that you have entered has been found in our system. Please follow the instructions for an existing account or use the forgot password link to access the correct account.
The following accounts match the entered email address: