New Membership Application

Step 1 of 2—Your Professional Information

Thank you for choosing to become a member of CaRVTA! Please be sure to fill out all fields of this form.

THIS FORM IS FOR CREDIT CARD PAYMENT ONLY! If you would like to pay by check, instead of credit card, please click here for a printable application form. For credit card payments: After you hit Submit, you will be sent to a secure page for your credit card payment. We Do Not Process Applications Until Payment Has Been Received.

After receipt of your payment (Step 2), you will be e-mailed your username and password so that you can begin to access CaRVTA's member-only areas. Please allow 2 business days for processing of your information.

If you are a prospective Student Member, please click here for a Student Membership Application.

Member Name

Employer:

Telephone:

Address:

City:

Zip Code:

State:

*Bill-to Name / Name on Credit Card (if different from Member Name):

RVT License #: