Application For Membership


First Name:
Middle Name:
Last Name:
Degree:
Gender:
MaleFemale
Preferred Contact:
HomeOffice

Home

Address:
 
 

City:
State:
ZIP
Country:
Phone:
Fax:
Email:

Office

Address:
 
 

City:
State:
ZIP
Country:
Phone:
Fax:
Email:

Medical School:
Year Graduated:

Residency Inst.:
Start Date:
End Date:

Board Certification:
YesNo
Type:
Year Certified:

Sub-Specialty:
Indicate primary specialty for directory listing.
Use the Ctrl to select multiple items:
                             
Other Specialty:

Group Practice Member?:
YesNo
Group Name:
City/State:

Practice Type:
   Diagnostic Radiology
   Therapeutic Radiology
   General Radiology
   Nuclear Medicine
   Radiation Oncology

Present Position:
   Academic
   Private Practice Salaried
   Private Practice Partner
   Trainee
   Retired
   Government

Organizational Membership:
   ACR
   RSNA
   ARRS
   AUR
   ASTRO
   AMWA
   AMA
   SPR
   ASNR
   Other:   

Indicate which committees (if any) you would like to serve on:
   ACR Activities
   Awards
   Bylaws
   Corporate Support
   Finance
   International
   Legislative
   Member-in-Training
   Membership
   Nominating
   Outreach-Med Students/Regional
   Private Practice
   Program
   Promote the Advancement of Women
   Public Relations
   Radiation Oncology
   Salary Equity
   Strategic Planning
   Website

Languages Spoken:

Membership Categories & Dues: 



   Active Members may vote and hold all offices. Associate members may vote and serve on committees but may not hold office. Members-in-training may not vote or hold office but may serve on some committees with vote. Emeritus Members shall have the right to vote and serve on committees, but shall not have the right to hold office. Corresponding International Members may serve on Ad Hoc Committees but shall not have the right to vote or hold office. Membership year is the calendar year.



   Only checks are accepted with the online application. If you prefer to pay by credit card, please print off the application and mail to AAWR.



Payment Type:
   Personal Check
   Personal Check Number:   
   Business Check
   Business Check Number, if known: 
   N/A -- Complimentary