Retired Practitioner Member – Not Auto-Renewing

Price:

$25 for 1 Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Phone Number:* Phone Number is Required

County:* County is Required

AOTA Member Number (if applicable) : AOTA Member Number (if applicable) is not valid

Arizona OT License Number : Arizona OT License Number is not valid

Congressional District (to find your district see link at top of this page):* Congressional District (to find your district see link at top of this page) is Required

Legislative District (to find your district see link at top of this page):* Legislative District (to find your district see link at top of this page) is Required

Gender: Gender is not valid

Female Male Other not listed Prefer not to answer

Ethnicity: Ethnicity is not valid

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander Hispanic or Latino Caucasian/White Other not listed Prefer not to answer

Position/Title:* Position/Title is Required

Employer/School: Employer/School is not valid

Business Address (put N/A if not applicable): Business Address (put N/A if not applicable) is not valid

Business City: Business City is not valid

Business State: Business State is not valid

Business Zip: Business Zip is not valid

What School Did You Graduate From / Are You Attending?: What School Did You Graduate From / Are You Attending? is not valid

Degree: Degree is not valid

Graduation Date: Graduation Date is not valid

Area(s) of Practice/Interest: Area(s) of Practice/Interest is not valid

Are You Interested in Participating in a Committee and/or District?: Are You Interested in Participating in a Committee and/or District? is not valid

Education Publications Finance Legislative Affairs Marketing and Public Relations Nominations and Recognition Diversity, Equity & Inclusion Ad Hoc Tucson Group

Are You Interested in Participating in a Special Interest Section?: Are You Interested in Participating in a Special Interest Section? is not valid

Neuro Pediatric Postsecondary Transition SIS Home Health Telehealth Home Modifications Teaching and Learning

ArizOTA also provides information to third parties, including businesses and other organizations, for a fee. This information might include member names, email addresses, and/or mailing addresses.:* ArizOTA also provides information to third parties, including businesses and other organizations, for a fee. This information might include member names, email addresses, and/or mailing addresses. is Required

Yes, ArizOTA may provide my information to 3rd parties No, do not provide my information to 3rd parties

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

*

Coupon Code:

Invalid Coupon