SMRT Membership Application
Please print, complete, and mail
or fax the application and membership dues to:
SMRT Section for Magnetic Resonance Technologists
P.O. Box 45690, San Francisco, CA 94145-0690 U.S.A.
Fax: +1 (510) 841-2340
1.
Applicant Information
Last Name:
First
Name
Modality
Male
Female
Addresses (Please provide both and
check preferred mailing address)
Office
Institution/Company:
Street:
Town/City:
State/Province:
Zip/Postal/Code:
Country:
Telephone:
Fax:
Email:
Home
Street:
Town/City:
State/Province:
Zip/Postal/Code:
Country:
Telephone:
Fax:
Email:
2.
Technologist/Radiographer
Certifications
Date of Registration/Certification:
Registration/Certification #:
Educational Degree:
Modality/Certifications:
Certifying Body:
3.
Please list work experience or attach a current resume (must include dates).
Employer:
From:
To:
Job Title:
4.
Membership Categories & Qualifications:
(Please check one
category). Prior to final acceptance by the SMRT Policy Board, each
application is reviewed by the Membership Committee for verification of
eligibility.
Basic Technologist (Voting) Member
In order to qualify as a voting member, you must be one of the
following:
A. Certified by the American Registry of Radiologic Technologists;
B. A Registered Diagnostic Medical Sonographer;
C. A Certified Nuclear Medicine Technologist; and/or
D. Certified by an equivalent professional certifying organization,
and you MUST have practiced as a technologist in the field of
magnetic resonance for a minimum of one year. The applicant MUST
submit a COMPLETED SMRT application form and verification of the
above.
Sponsorship: Provided by SMRT Membership Committee.
I verify the above named applicant has at least two years' practice
in an NMR modality.
____________________________________________________________________________________
Department Head/Administrator signature
Technologist (Nonvoting) Member
An individual who shares the stated purposes of the SMRT but does not meet the
qualifications for voting membership. The applicant MUST submit a COMPLETED SMRT
application form.
Sponsorship: Provided by SMRT Membership Committee.
SMRT
membership runs on a calendar year basis and is effective January 1
through December 31. Membership applications may be submitted
year-round, however, please note the following:
Applications submitted and approved
between January 1 and September 30 are effective for the
current calendar year;
Applications submitted and approved
between October 1 and December 31 are effective the
following calendar year, unless the applicant specifically
requests to join for the current calendar year.
Basic Membership:
US$80 per year for 2008
Technologist with journal Magnetic Resonance in Medicine:
US$185 per year for 2008
Technologist with journal Journal of Magnetic Resonance Imaging:
US$185 per year for 2008
Technologist with both journals:
US$290 per year for 2008
Student Membership
US$30 per year for 2008
Student Membership with Magnetic Resonance in Medicine journal:
US$135 per year for 2008
Student Membership with Journal of Magnetic Resonance Imaging
US$135
per year for 2008
Student Membership with both journals:
US$240 per year for 2008
Check, Travelers Check, International Money Order: Please make checks payable to SMRT.
Must be payable "to" (not "through") a U.S. bank in U.S. dollars and must be
imprinted with the computer encoding and routing information authorized by
the American Banking Association. WIRE PAYMENTS NOT ACCEPTED.
CREDIT CARD INFORMATION
Visa
MasterCard
American Express
Card #
-
-
-
Exp. Security Code
Cardholder's Name and Address
Billing Street Address
Please send completed form with necessary documents and payment to:
International Society for Magnetic Resonance in Medicine
Membership Director
P.O. Box 45690
San Francisco, CA 94145-0690 USA
5.
Dues Payment Options
SMRT
membership runs on a calendar year basis and is effective January 1
through December 31. Membership applications may be submitted
year-round, however, please note the following: