Membership Application


MAOT - Massachusetts Association for Occupational Therapy, Inc.
 57 Madison Road - Waltham, MA 02453-6718
 p: 781.647.5556 - f: 781.642.9742 - e: maot@gis.net

 

 

STEP 2: Enter Information and Print

 

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Contact Information  
 
First Name*
Last Name*
  Member Status* New Member
Renewing Member
   
       
  Residential   Business
 

Address*

 
City*
State**
Zip*
Phone*
Fax
Email*
 

Address

 
City
State
Zip
Phone
Fax
Email
       
What type of information would you like to receive from MAOT?
 
Employment Listings Advertising
Continuing Education Governmental & Legislative Action
Volunteer Positions Other
           
Special Interest Group (Member Benefit)
 
Emerging Practice Areas School Based
Mental Health State Employed
North Shore OTA Technology SIG
  I am interested in forming a new special interest group. Please send me information
 

*Membership Fees

(only select one category)
  Occupational Therapist (OT) - $75
  Occupational Therapy Assistant (OTA) - $60
  Student of Occupational Therapy (OTS) - $30
           
Donations & Contributions
Karen Jacobs Scholarship Fund $  
MAOTPAC (Political Action Fund) $
 

Please make your check payable to MAOT and enclose with completed application

Mail to: MAOT -  57 Madison Road - Waltham, MA 02453-6718