Membership Form

AVRT Membership Form

New Membership or Renewals
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*

Confirmation Email
Employer:
Job Title:
AVRT Directory
Do you have any special interests or areas of expertise?
How many years have you been in Rehabilitation?
Regular Membership Dues are $50.00 Yearly + $3 PayPal Fee.

Membership from:

(January 1st to December 31st)

IF YOU DO NOT HAVE A PAYPAL ACCOUNT AND WANT TO PAY WITH YOUR CREDIT CARD, THEN AFTER CHOOSING YOUR MEMBERSHIP OPTION, GO AHEAD AND HIT THE "PAYPAL" OPTION. THEN WHEN IT GOES TO THE NEXT SCREEN, AT THE BOTTOM IS WHERE YOU CAN CHOOSE TO PAY WITHOUT HAVING TO HAVE A PAYPAL ACCOUNT.

My Products (Please choose only one option)*

Regular Membership Dues$53.00

Membership Dues are $50 plus a $3 PayPal charge.

Canadian Membership Dues$48.00

Membership is $45 plus a $3 PayPal charge.

Students and Retired Membership Dues$43.00

Membership Dues are $40 plus a $3 PayPal charge.

LIFETIME MEMBERSHIP $618.00

Lifetime membership for 2025 is $600. = $18 paypal fee.

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Total $0.00

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