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Active Membership-New Members

I hearby make application for active membership in the Ohio Society of Radiologic Technologists. If accepted, I agree to support the bylaws of the Society; to conform to the code of ethics adopted by the Society; and to renew my membership each year by paying my dues upon receipt of statement. Should I desire membership cancellation, I shall notify the Executive Secretary in writing.


First Name (*)
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Last Name (*)
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Email Address (OSRT will not sell) (*)
Please enter a valid email of the form userid@email.com
Gender
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Home Address (*)
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Home City (*)
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State (*)
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Zip Code (*)
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Home Phone-No dashes (*)
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Work Phone (*)
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Cell Phone
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County (*)
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Credentialing Organization (Choose One Primary) (*)


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Registry Number (*)
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Please notify the EXECUTIVE SECRETARY in writing
of any changes in status or address.

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Credentials (Check one or more)















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Referring Member Name
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Degree (*)
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Position (*)
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Work In (*)
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Are you a member of ASRT?
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Interested in running for an OSRT board position?
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Interested in serving on an OSRT Committee?
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DUES: $35/Year. Multiple year memberships available at reduced rates: Two-year: $65; Three-year: $90.
Payment Options
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Membership Length (*)
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Birth Month (*)
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Birth Year (*)
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If mailing payment, please make check or money order payable to:
 Ohio Society of Radiologic Technologists.

If the application is not accepted, the entire amount will be refunded.

Note: Submit application electronically and mail the payment or credit card information to:
Sheryl Bacon, R.T.(R)
 507 Sycamore Ct
Marion, Ohio 43302
Toll free (866) 405-OSRT (6778)
(Fax) (888) 317-9472
osrt@osrt.org
Form Verification (*) Form Verification   Refresh
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STATEMENT

The Ohio Society of Radiologic Technologists (Business Association) is a tax exempt entity under Internal Revenue Code section 501(c)(6).
Notice of Membership Dues

In accordance with Sec. 6033(e) of the IRS, please be advised that 7.5% of membership dues allocated to legislative activities of OSRT, and as such, may not be deductible for tax purposes.
 
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