OOTA Membership form  Certified Occupational Therapy Assistant

First Name:
Last Name:
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Address Second Line:
City:
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Home Phone Number:
Employer:
Work Phone Number:
Work Address
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NBCOT Certification #
Oklahoma Licensure #:
Your membership is a

OOTA Volunteer Interests: Check all that apply:

Community Promotion of OT Leadership Development
Professional Promotion of OT

Newsletter Development/Article Writing
  Reimbursement for OT Nominations/Recognitions Committee
Membership Committee Facilitate a workshop on
Finance (Fundraising) Committee Assist with meeting registration/set up
Annual Conference Continuing Education Committee

 

Please indicate any other way that you would like to be involved in OOTA for the coming year.

When you submit this form the information will be forwarded to OOTA. You will be redirected to a page where you will submit payment information. 

Oklahoma Occupational Therapy Association
PO Box 2602 Oklahoma City, OK 74101-2602
(918) 231-1300
Contact OOTA
Updated April 03, 2008