Technologist Auto Renew Membership

Terms:

$25 / Year

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

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

Employer Name: Employer Name is not valid

Employer Address: Employer Address is not valid

ARRT Certified?:* ARRT Certified? is Required

Yes No

ARRT #: ARRT # is not valid

ARRT Modalities: ARRT Modalities is not valid

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

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

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