Thank you for joining RAC! We will email you.

First Name * Last Name * Email * Mailling Address * City, State and Zip * Mobile Phone Date of Birth (full date or day & month only) Website Address

Do you want a listing in the online directory

Yes No

Professional Dues *

New or renewed membership per year: ($75 USD) New or renewed membership 2 years: ($140 USD)

Your ARCB Certification Number Your RAA Member Number

Are you an ICR member?

Yes No

School Name and location *

How did you hear about RAC?

Colleague Friend Instructor Fair/Event RAC Website RAC Newsletter Flyer/Brochure

If you were referred, name of person who referred you

Please verify: *

ARCB or RAA card copy emailed to RAC I meet the requirements for Professional member If any of the above is found incorrect, my membership can be denied

Signature * Date *

* indicates required fields