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Application Form 6 West Dry Creek Circle, Suite 200, Littleton, CO 80120-8031 T Yes, I would like to save $10 and order the Certifying Exam Study Guide at $55 (plus $7.50 shipping). Savings for current and joining AST members only. T NONMEMBERS: Certifying Exam Study Guide $65 (plus $7.50 shipping) Name ______________________________________________________________________________ Address _______________________________________________________________________________________________ City _____________________________________________________________________ State ____________ ZIP ________________________ E-mail ______________________________________________________ Phone ____________________________________________________ School _________________________________________________________________________________ Graduation Date _____________________ I am paying by T Check enclosed T VISA T MasterCard # __________________________________________________________________ Expiration Date _________________ Total enclosed ________________________ Signature ______________________________________________________________________________________________________________________________________ Now it pays even more to be a member of AST—especially for students. Your savings begin right away when you apply for the special student membership rate, $45 (a $35 savings). Save $10 with the member discounted price of the examination study guide, $55 and save $100 when you take the national certifying examination. Enjoy the benefits of membership in the premier national professional organization for surgical technologists. Join online at www.ast.org; by phone at 800-637-7433; or by mail (fill in the application below). JOIN AST VE $100 ON THE CST ® NATIONAL CERTIFYING EXAM egistered trademark of the National Board of Technology and Surgical Assisting. Member price: $190 Nonmember price: $290 2016 CERTIFYING EXAM FEES