PSRTonline





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2012 MEMBERSHIP APPLICATION FOR STUDENT TECHNOLOGISTS

Online payment with a Credit Card or Paypal account.

A Paypal account IS NOT required.

Complete the form, fill in the re-captcha, and click SEND to be routed to the PSRT Paypal payment site.

A confirmation email is sent to the address entered.  This is your receipt.  Remember to print the Paypal receipt as well.


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* Required information.
Date *
New Membership or Renewal? *
Membership level *
First Name *
Middle Initial / Name
Last Name *
Address 1 *
Address 2
City *
County *
State *
Zipcode *
Home Phone *
Email Address *
ASRT member?
Name of school? * Please name the educational institution you attend.
Program Director's name.
Anticipated year of graduation. *

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