Membership Application

Use the online application form for all methods of payment. Complete the form using your keyboard and submit it online, or print out your transaction summary and send via fax or USPS mail with your credit card information or check. Choose the method that works best for you. You can use your transaction summary to submit to your accounting department when requesting a check payment.

DUES
RBMA dues are based on the calendar year, January 1st - December 31st. New member dues are prorated quarterly. All members are billed January 1st for the calendar year dues, regardless of when they joined. A $50 one-time, non-refundable enrollment fee is included in new member dues.

	January to December	April to December	July to December	October to December
Active	$375	$320	$265	$210
Additional Member from a Practice	$250	$200	$150	$100
Additional RBMA Bulletin Subscriptions	$100	$75	$50	$25
Corporate Representative #1	$1050	$1000	$950	$900
Corporate Representative #2 (included)	-
Additional Corporate Representative	$250	$200	$150	$100

ONLINE-credit card payments
Complete the online application form and include your credit card information for payment online. Visa, MasterCard and American Express are accepted. Your credit card will be charged and you will receive a summary of your transaction immediately.

FAX-credit card payments
Complete the online application form and choose your payment option. After you submit the application form, you will receive a summary of your transaction. Print out the transaction summary and fax with your credit card information.

FAX 703.621.3356

MAIL-check or credit card payments
Complete the online application form and choose your payment option. If you are paying by check, please make checks payable to RBMA. After you submit the application form, you will receive a summary of your transaction. Print out the transaction summary and mail with your check or credit card information to:

RBMA
10300 Eaton Place, Suite 460
Fairfax, VA 22030

CONFIRMATION
Upon receipt of your application form and payment, a confirmation via email will be forwarded.

HELP
Contact RBMA at 888.224.7262 or e-mail info@rbma.org

Please check the category that best describes your employer:
	A vendor company that sells products and services to radiology practices and/or imaging centers.
	A consulting firm, sole proprietor consultant or a CPA firm
	A company that performs billing or management services for physician practices
	A radiology practice(s) owned by radiologists, or a medical practice(s) owned by a combination of radiologists and other non-radiologist physicians
	A hospital or hospital system
	Imaging center(s) or radiation oncology center(s) owned by non-physicians or a mixture of physicians and non-physicians (includes joint ventures owned by physicians and a hospital or health system)