OSRT Fellows (FOSRT) Application

Complete this application if you intend to apply for Fellows status in the OSRT. Log in above using your existing user name and password. Be sure to read the most current published guidelines, rules and scoring rubric. Complete and electronically submit this official application on or before May 15. Click the submission button below after completing this application.

OSRT Financial Amount *

OSRT Fellow (FOSRT) Application Fee - $ 50.00

Total Amount

First Name

Last Name

Phone

Street Address

City

State

Postal Code

Credentialing Org

ARRT

ARDMS

NMTCB

CV/Resume *

Application supporting info

Credit Card

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Card Type

Card Number *

Security Code *

Expiration Date *

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Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *