Student Membership ***When completing the membership form, please use the email address provided by your educational institute for the Student Email field and please use a Personal Email for the Email field. Price: Available to students enrolled in a radiography program. $10 for 1 year of Student membership. May renew membership as long as enrolled in radiography program. First Name:* First Name Required Last Name:* Last Name Required Address Line 1:* Address Line 1 is Required Address Line 2: Address Line 2 is not valid City:* City is Required Country:* Country is Required -- Select Country -- United States (US) Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe State/Province:* State/Province is Required Zip/Postal Code:* Zip/Postal Code is Required Home Phone:* Home Phone is Required Work Phone: Work Phone is not valid ARRT Certified?:* ARRT Certified? is Required Yes No ARRT #: ARRT # is not valid ARRT Modalities: ARRT Modalities is not valid N T MR S CV M CT QM BD VS CI VI BS RRA R Other Certifications: Other Certifications is not valid ASRT Member?:* ASRT Member? is Required Yes No ASRT #: ASRT # is not valid How did you hear about the ALSRT? (Select all that apply):* How did you hear about the ALSRT? (Select all that apply) is Required From an ALSRT member ALSRT website ASRT ARRT Employer Facebook Instagram Word of mouth Radiography Program Director/Instructor Full name of person who encouraged you to join the ALSRT?: Full name of person who encouraged you to join the ALSRT? is not valid Name of School:* Name of School is Required --Select School-- DCH Regional Medical Center Gadsden State Community College George C. Wallace Community CollegeHuntsville HospitalJefferson State Community CollegeNorthwest-Shoals Community CollegeSouthern Union State Community CollegeTrenholm State Community CollegeUniversity of South Alabama Wallace State Community CollegeOther Date of Graduation:* Date of Graduation is Required I would be interested in: I would be interested in is not valid Serving on a Committee Helping with a Meeting Speaking at a Meeting Student Email:* Student Email is Required Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Have a coupon? Coupon Code: Invalid Coupon Coupon applied successfully Pay with PayPal Pay with Check Please make check payable to "ALSRT" and mail to: ALSRT P.O. Box 8641 Mobile, AL 36689 **Membership will not be active until payment is received** I have read and agree to the Terms and Conditions* Yes, I want to receive emails from ALSRT including Conference Registration, Licensure Updates, Online CE Announcements, and more! We Respect Your Privacy No val Please fix the errors above
