Kansas Society of Radiologic Technologists Membership Application

Type Of Application*

Name*

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Membership Type*

ACTIVE MEMBER: Certified by ARRT and Member of ASRT and practicing in the field of radiologic technology. MUST SUBMIT copies of ARRT and ASRT CardASSOCIATE A MEMBER: Certified by ARRT and practicing in the field of radiologic technology. COPY OF ARRT CARD MUST BE SUBMITTEDASSOCIATE B MEMBER: Persons practicing in the field of radiologic technology not certified by the American Registry of Radiologic technologists and are not registry eligible; or, those persons interested in promoting the purposes and functions of the KSRT, but are not eligible for Active, Associate A, Life, Senior or Student membership.SENIOR MEMBER: Certified by ARRT and 65 years old or more. SEND COPIES OF ARRT CARD AND BIRTH CERTIFICATE OR DRIVER’S LICENSE.STUDENT MEMBER: Enrolled in an approved school of radiography for a MINIMUM of 24 months.

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Date of Enrollment (Students Only)

Anticipated Graduation Date (Students Only)

Date of Application*

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Membership Type*

Active Membership$50.00

Associate A or B Membership$50.00

Life Member$ Free

Senior$25.00

Student$25.00

By submitting this form, you are agreeing to abide by the Bylaws of the Kansas Society of Radiologic Technologists. You are also aknowledging the information submitted is correct and accurate. You are also agreeing to pay the membership dues.

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Kansas Society of Radiologic Technologists Application