Membership Form If you already have an account on our website, please log in to continue * Membership Type Technologist $30.00 for one year 1 year Radiologic Technologist membership Student Membership $10.00 for one year 1 year student membership Payment System PayPal secure credit card payment Name * First & Last Name Address Information * Street * City * State * ZIP Code Contact Information * Home/Cell Phone Work Phone * Your E-Mail Address a confirmation email will be sent to you at this address ALSRT Account * Choose a Username it must be 6 or more characters in length may only contain letters, numbers, and underscores * Choose a Password must be 6 or more characters * Confirm Your Password Employer Information Employer Name Employer Address Student Members Only Name of School Date of Graduation Background Information ARRT Certified? Yes No ARRT # ARRT Modalities R N T MR S CV M CT QM BD VS CI VI BS RRA Other Certifications ASRT Member? Yes No ASRT # Full name of person who encouraged you to join the ALSRT? I would be interested in Serving on a Committee Helping with a Meeting Speaking at a Meeting Built on aMember Pro™ membership software