MAOT
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, Print, and Mail

* requires fields

Contact Information     First Name* Last Name*   Member Status* New Member Renewing Member               Residential   Business   Address*   City* State** MA Zip* Phone* Fax Email*   Address   City State MA 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: 1) Print this page when it is completed 2) Attach a check for the appropriate amount (make your check payable to MAOT) 3) Enclose the check with completed application and mail to: MAOT 57 Madison Road Waltham, MA 02453-6718 Return to MAOT Home Page