Sustaining Not AOTA / AutoRenewing

Terms:

$105 / 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

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 N/A

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

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 Ad-H Tucson District

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 Vision

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

Sustaining Member Registration