Membership Application

Click here to download a printable version of the Membership Application to mail to:

National Rehabilitation Association
633 South Washington Street
Alexandria, VA 22314

Fields marked with an asterisk (*) are required.
Regional and State Chapter Memberships at all levels are included at no additional charge.

   
Member:*
First Name:*  
Last Name:*  
Address:*  
City:*  
State:*   State
Zip:*  
Work Telephone:*  
Home Telephone:*  
Fax:
Name on Credit Card:  
If you plan on paying by credit card and the name on that card differs from your name, please provide the name on the card here.
Email Address*  
Who Introduced you to the NRA?:  
     
NRA Annual Membership Categories
Note for Students
A Full-time undergraduate student must have a minimum of eight (8) hours per semester or the equivalent and a Full-time graduate student must have a minimum of six (6) hours per semester or equivalent.  Please print application and mail or fax with the following information.
     
I hereby certify that  
is a full-time student at
Expected date of graduation:  
Signature of Major Professor:  
Telephone of Major Professor:  
Donor Support Categories
Please note: Dues are non-refundable and membership is non-transferable, but fully portable should you change your employer. A $15 charge will be assessed for returned checks. Membership is good for 12 months from the date your payment is processed. If you do not wish for your name to appear on commercial lists, please contact the national office.
     
Division Annual Fees
Membership in NRA is required to be eligible for division membership.
     
Rehabilitation Counselors and Educators Association
     
National Rehabilitation Association of Job Placement and Development
     
National Association for Rehabilitation Leadership
     
Vocational Evaluation and Work Adjustment Association
     
National Association of Disability Benefits Specialists
     
National Association of Rehabilitation Technicians
     
National Association for Independant Living
     
National Association of Service Providers in Private Rehabilitation
     
National Association of Multicultural Rehabilitation Concerns
     
Transition Specialties Division
     
Rehabilitation Program Evaluation Network
     
The portion of the membership fee set aside for the NRA's two publications is $9.25 for the Journal of Rehabilitation and $8.85 for Contemporary Rehab. Please help your Association to save expenses by not using credit cards for charges under $10.00. Thank you.
     

Payment Information
If paying by check or money order, print this completed form and send along with your check/money order payable to National Rehabilitation Association, 633 South Washington Street, Alexandria, Virginia 22314.

If paying by automatic bank draft, please print and complete this application, attach a voided check or deposit slip, and mail to National Rehabilitation Association, 633 South Washington Street, Alexandria, Virginia 22314.

NRA Bank Draft—Authorizing NRA to debit your checking or savings account. There is a $1 per month processing fee.
Signature: 

  Monthly — Please attach a voided check.

If paying by Credit Card


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Please note: Dues are non-refundable and membership is non-transferable, but fully portable should you change your employer. A $15 charge will be assessed for returned checks. Membership is good for 12 months from the date your payment is processed. If you do not wish your name to appear on commercial lists or do not want to receive e-mail updates regarding legislation or association updates and training opportunities, please contact the national office at 703-836-0850.