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Membership   >   Membership Application
February 22, 2012
Application for Membership

 

We are always looking forward to having new members join our group and we encourage you to fill out our application. If you would like to join the Iowa Society of Radiologic Technologists you will need to fill out our new member application along with your submission of payment.

We have two options to process your application. You may use the online application form, which is below, and you will be asked to submit your membership payment via online through our secure credit card processing. If you do not wish to submit your member application online you may submit a paper copy of your application and mail it along with your membership payment to:

JoAnn Horsfield, Exec. Sec.
17060 County Road D-62
Monticello, IA 52310

* Please include a copy of your ASRT card when you are submitting your member application via the mail.

* Please click here to print the ISRT Membership Application form: ISRT Application.pdf

Thank you for your interest and submission. We look forward to having you as a member!

Membership Type:
First Name:
 Last Name:
Street Address:

 Area:
City:
 State:
Zip code:
 Phone:
Maiden Name:
Email:
Check All Categories That Apply:
1.
  Other:
2.
American Registry Of Radiologic Technology (ARRT): ARRT #:
American Society Of Radiologic Technologists (ASRT): ASRT Number:
  Expiration Date:
I have applied for membership to ASRT: Application Date:
Previous ISRT Member:
3.
Student:
Radiologic Technology Program:

Graduation Date:
3.
Limited Radiographer:




ACTIVE (Must be ASRT & ARRT) $40.00
ASSOCIATE (Must be ARRT) $45.00
STUDENT (Currently in Radiologic Technology Program) $15.00
SUPPORTING (Not ARRT) $45.00
INACTIVE (No longer employed in the Radiologic Sciences) $40.00
My membership in ISRT has expired. I understand that I must pay a $5.00 reinstatement fee.
I hereby make application for membership in the Iowa Society of Radiologic Technologists. I agree to support the Constitution and Bylaws of the Society and conform to the Code of Ethics adopted by it.
My typed name below shall have the same force and effect as my written signature.
Signature of Applicant: Date:
Redirect URL:
Fees:
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