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SDRehabACTion Membership Form
Complete this form to become a new member of RehabACTion or to renew your current membership.
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What type of membership are you registering for?
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New Member
Renewal Membership
First Name
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Your answer
Last Name
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Your answer
Employer
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Your answer
Job Title
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Your answer
Mailing Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Membership Dues
Membership dues are due with this form. A 1 year membership is $35.
Checks can be mailed to:
SD RehabACTion Inc.
PO Box 175
Pierre, SD 57501
Credit card payment will be accepted via PayPal:
https://www.paypal.com/webapps/shoppingcart?flowlogging_id=f69557318ba65&mfid=1722962067561_f69557318ba65#/checkout/openButton
Cash payments will be accepted at the Fall Conference registration table
*A current membership form and payment is required to be eligible for the Fall Conference RehabACTion member giveaway
*If you are student in a rehabilitation master's program your membership is free
Payment Method
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Check by Mail
Credit Card (via Paypal)
Cash (at Fall Conference only)
I am a student in a rehabilitation master's program
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