Membership Checkout

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Membership Information

You have selected the Student membership level.

An individual enrolled in an approved OT or OTA curriculum

The price for membership is $25.00 per Year.

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Email Address

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Full Name LEAVE THIS BLANK

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Professional Credentials

Professional License No

County (e.g. Franklin)

Preferred District

Preferred SIS Group

Areas of Practice

Click the empty field for a dropdown menu - you can click again to select as many as apply.

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Card Number

Expiration Date

Security Code (CVC)

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