Membership - Join or Renew

 *Name: Please enter your nameYou may not enter more than 65 characters, including spaces

 *Current Address: Please enter your current street addressYou may not enter more than 65 characters, including spaces

 *Current City: Please enter your current cityYou may not enter more than 65 characters, including spaces

 *Current State: Please enter your current state     *Current Zip: Please enter your current zip codePlease enter your current 5 digit zip code

   Permanent Address:

   Permanent City:

   Permanent State:      Permanent Zip:

 *Primary Phone: Please enter your main phone numberPlease enter a valid phone number, e.g. (555) 555-5555     Secondary Phone:

 *E-Mail Address: Please enter your e-mail addressPlease enter a valid e-mail address, e.g. jdoe@domain.com

 *Credentials (select only one):
    CTRS/R
    CTRS
    Recreational Therapist Registered
    None
Please make a selection.

 Other Credentials:

 Employer:

 Postion (select all that apply):

  Therapist

  Supervisor

  Administrator

  Consultant

  Assistant

  Aide

  Educator

  TR/RT Student

  Other   

 Practice Area (select all that apply):

  Academia

  Adult Day Health

  Corrections

  Developmental Disability

  Extended Care

  Geriatric Wellness

  Geropsych

  Pediatrics

  Physical Rehabilitation

  Psych Forensic

  Psych General

  Recreation General

  Recreation Inclusive

  Recreation Special

  Schools

  Substance Abuse

  Youth-at-Risk

  Other   

 *Mentorship Program (select only one):
    I would like to be a mentor (must be a Professional/Emeritus member).
    I would like to have a mentor (must be a Student member).
    I do not wish to participate in the Mentorship Program at this time.
Please make a selection

 I would like to assist WSTRA in the following ways (select all that apply):

  Board Member

  Electronic Updates

  Financial Aid Disbursement

  Fund Development

  History of WSTRA

  IN Groups

  Leadership Development

  Member Recruitment & Retention

  Newsletters

  Officer Nominations

  PR/Marketing

  Professional Development Online (Webinars & CBT)

  Professional Development Presenting   Topics:

  Professional Development Student Experiences

  Professional Development Symposium

  Professional Development Workshops

  Public Policy

  Recognition

  Website

 *Information Privacy (select only one):
    WSTRA may provide my information as determined by the WSTRA Information Security policy.
    Do not provide my information to organizations or individuals outside of WSTRA and its members.
    Do not provide my information to WSTRA members or include it in printed or electronic directories.
    Do not provide my information to WSTRA members, organizations or individuals outside WSTRA or include it in printed or electronic directories.
Please make a selection.

 *Select only one dues category:
    $25.00 Professional (must hold CTRS/R, CTRS or RRT)
    $15.00 Professional Emeritus (retired from TR/RT practice, must hold or have held CTRS)
    $10.00 Student (must be enrolled full-time in a higher education TR/RT curriculum)
    $15.00 Supporting (does not qualify in above categories)
    $75.00 Organizational
Please make a selection.

  -$5.00 ATRA/NRPA discount, membership number:

  *TOTAL DUES: Please calculate and enter your dues total.Must be in American Dollar format, e.g. 0.00Must be at least $5.00Cannot be more than $75.00