Join IOTA

Please check the following

First Name

Middle Initial

Last Name

Preferred Email

Home Address

City

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Zip Code

Preferred Phone

Preferred Fax Number

Credentials

Areas of Practice - Select All That Apply Academic & FieldworkChildren & Youth Health & Wellness Mental Health Productive Aging Rehabilitation & Disability Technology Work & Industry

Are you AOTA Board Certified? Select one...YesNo

List Area

Are you AOTA Specialty Certified? Select one...YesNo

List Area

May we include your certification information in the IOTA Membership Directory & Handbook? Select one...YesNo

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Employer

Work Phone

Work Address

City

State Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

District Select oneNortheastSoutheastNorthwestSouthwestCentral

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School

Graduation Date

Status Select one...Undergraduate StudentGraduate StudentGraduating within 6 months

May your name be made available for other organizations for business or mailing purposes? Select one...YesNo

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Volunteer Area

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Annual Membership Fee

Total Price

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