OOTA Membership form  Registered Occupational Therapist

First Name:
Last Name:
Address First Line:
Address Second Line:
City:
State:
Zip:
Home Phone Number:
Employer:
Work Phone Number:
Work Address
Work Address Second Line:
City:
State:
Zip:
Email Address:
Fax Number:
NBCOT Certification #
Oklahoma Licensure #:


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.

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