Alaska Occupational Therapy Association
Online Membership Application 2011
Membership from January 1, 2011 to December 31, 2011
If you are paying by check, it should be made out to AKOTA and sent to:
AKOTA Treasurer, PMB 1616, 3705 Arctic Blvd., Anchorage, AK 99503
Please be sure to indicate who you are paying for so we can apply payment accurately.
Membership category
New member or renewal?
Mailing Address
What is your primary practice setting?
What is your primary field of practice?
What is the highest degree that you hold (in any area)?
What can AKOTA provide for you? Check all that apply
Would you be willing to help out in any of the following? Even a small amount of time is valuable!
Do you have any AOTA Board or Specialty Certifications?
Do you have any other certifications?
Payment Method ( PayPal preferred)
Submit your application. You will then be taken to a page for payment.
Reset form. Do not press this unless you want to start over
