2022 – 2023 Volunteer Application

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2023 - 2024 Officer Elections
92nd Annual Meeting & Educational Symposium: April 20 - 22, 2023

2022 – 2023 Volunteer Application

Name *

First

Middle

Last

Email *

Valid email. Please provide an email that is regularly monitored.

Phone *

City/Region *

Are you a member of the TXSRT? *

If "Yes", you will need your TXSRT member number. https://txsrt.org/membership-card/ . Login required.

TXSRT Membership Number *

Are you a member of the ASRT? *

If "Yes", you will need your ASRT member number. www.asrt.org. ASRT is encouraged, but not mandatory for all opportunities.

ASRT Membership Number

Are you a professional or student? *

Professional (registered in at least one primary modality)
Student (non-registered individual; currently enrolled in an accredited medical imaging/ radiation therapy program)

As a professional volunteer, I understand certain volunteer opportunities may require a current ARRT registry status, an active TMB licensure, and/or membership to the ASRT, TXSRT, and/or my local subordinate affiliate if applicable *

I acknowledge the aforementioned criteria
I understand this does not disqualify me from volunteer, but may limit specific opportunities.

Please check both statements after reading and accepting terms.

Academic Credentials *

AAS, BS, MS, PhD, etc.

Clinical Credentials *

ARRT, ARDMS, NMTCB, ARMRIT, etc. (ex: RT (R))

Professional Credentials *

CRA, CIIP, FACHE, etc.

Other Credentials

Any miscellaneous category not previously described

Enrollment Classification

Ex: 1st semester, 2nd semester, etc. or freshman, sophomore, junior, or senior

Expected Graduation Date

Format: TERM / YEAR (ex: Spring 2020)

Name of Institution

Where are you currently enrolled?

Modality of Program (Primary)

Magnetic Resonance
Nuclear Medicine
Radiation Therapy
Radiography
Sonography / Ultrasound
Other

Please explain Other (Modality)

Program Representative

First

Last

Official representative / leader of your program (director, department chair, sponsoring faculty or administrator)

Program Representative Email

Valid email. Please ensure this email is regularly monitored.

Program Representative Phone#

Official Title of Program Representative

I am interested in the following student opportunities *

Volunteering with committees, programs, and/or task forces
Internship
Other

Choose all applicable interests

Please explain Other

Area of Interests / Career Aspirations *

Example: Administration, Education, Corporate, etc. Please be as general or specific as appropriate. Information helps with intership/mentorship alignment.

Please select all Committees and/or Coordinator positions you are interested in: *

Affiliate Development Committee
Annual Meeting Committee
By-Laws Committee
Legislative/Advocacy Committee
Nominations Committee
Texas Student Leadership Development Committee
Education Coordinator
Fundraising Coordinator
Historian/Photographer
Social Media Coordinator
Student Contest Coordinator: Award of Merit Essay
Student Contest Coordinator: iLEAD Presentations
Student Contest Coordinator: RAD T-Shirt
Student Contest Coordinator: Scientific Poster
Webmaster

For more information, please review the Operational Guidebook with Standing Rules located on the txsrt.org home page under Operational Procedures of the main menu.

Local Area Committee Region

If you chose to volunteer to serve your Local Area Committee through the TSRT please select your Region in the dropdown. See full Texas Regions Map below

Briefly describe the skills, attributes, and/or experience you may possess to promote your success in the areas chosen above:

How did you become aware of the TXSRT Volunteer Process? *

TXSRT Website
TXSRT Communication (Email, Newletter, etc.)
Direct Communication from a TXSRT member
Previous Volunteering with TXSRT
TXSRT Event (Annual Meeting / Seminar / Membership Drive / Etc.)
Other

Select the most accurate option

Website

Contact Information