Associate Member

Remember to use the early bird code!

Use code EARLY-BIRD-ASSOCIATE to save by registering by December 31, 2024, 11:59 p.m. EST!

Price:

$360 for access until December 31, 2025

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Your Birthday:* Your Birthday is Required

Home Phone Number:* Home Phone Number is Required

Cell Phone: Cell Phone is not valid

Member's Degrees and/or Diplomas:* Member's Degrees and/or Diplomas is Required

What society or regional chapter would you like to belong to?:* What society or regional chapter would you like to belong to? is Required

Member's Employer: Member's Employer is not valid

Member's Job Title: Member's Job Title is not valid

Employer's Email: Employer's Email is not valid

Employer's Fax Number: Employer's Fax Number is not valid

Employment Phone Number: Employment Phone Number is not valid

Employment - City: Employment - City is not valid

Employment - Street: Employment - Street is not valid

Employment - Country: Employment - Country is not valid

Employment - Postal Code: Employment - Postal Code is not valid

Employment - Provice: Employment - Provice is not valid

Current VRA designation(s):* Current VRA designation(s) is Required

RVP RCSS RRP FVRAC None of the Above

Other Credentials - for example, CVRP, CVRP-TSA, CCVE, ICVE, RTWDM (enter NA for none): Other Credentials - for example, CVRP, CVRP-TSA, CCVE, ICVE, RTWDM (enter NA for none) is not valid

Are you a member of any other College of Practice?:* Are you a member of any other College of Practice? is Required

Yes No

If you had to choose your area of professional expertise, what would that be? Select only one option.:* If you had to choose your area of professional expertise, what would that be? Select only one option. is Required

Do you consent to the use of your personal information in accordance with the VRA Privacy Policy? :* Do you consent to the use of your personal information in accordance with the VRA Privacy Policy? is Required

Yes No

Do you consent to receiving emails from VRAC and/or VRA Societies? :* Do you consent to receiving emails from VRAC and/or VRA Societies? is Required

Yes No

Do you consent to the sharing of your name and email address with the Work Fitness Disability Roundtable so you can be added to their email list?:* Do you consent to the sharing of your name and email address with the Work Fitness Disability Roundtable so you can be added to their email list? is Required

Yes No

Would you like to use the "Bill Employer option":* Would you like to use the "Bill Employer option" is Required

Yes No

Indicate the email address of your employer who should receive a copy of the invoice: Indicate the email address of your employer who should receive a copy of the invoice is not valid

I understand that Members are responsible for reviewing their profiles for accuracy and for updating personal information including change of address, change of employer, etc. **

Please list the other colleges of practice you below to (if applicable): Please list the other colleges of practice you below to (if applicable) is not valid

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Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Description	Amount
Associate Member – Payment	$360.00
Total	$360.00

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