Online Membership Form and Payments:

PayPal Seal Credit cards
MOTA accepts credit card payments online through PayPal - we are a Verified Paypal Merchant. PayPal is used by virtually everyone on eBay, as well as many online merchants, and is 100% secure.

PLEASE NOTE: You may need to tell your browser to "allow the active (or blocked) content" on this page (for Javascript - look for a prompt at the top of the page) before using this form.


How to Join/Renew and Pay Online:

PLEASE NOTE: If your browser asks to "Allow the active (or blocked) content?" (look for a prompt at the top of the page), choose "yes" before using these forms.

  1. Fill out the membership form in Section I below (even if you are renewing).
    When finished, click on the "Submit Form" button (this information goes to our Membership committee).  We MUST receive this form to properly record your membership. This will take you to a confirmation page where you can check what you entered (to make corrections, you will need top submit another from). Then…
     
  2. IMPORTANT - Return Back To This Page to Pay!
    At the bottom of the confirmation page, click on "Back to MOTA Online Membership Form Page".
     
  3. Scroll down to Section II, "Please Pay for Your Membership".
    - Make your selections from the drop down menus under steps #1, #2, and #3.
    - Click the "Add to Cart" button. If you made an error and need to remove an item, just check the box under "Remove" and then click on "Update Cart".
    - If you would like to Make a Donation, click on "Continue Shopping", then go to the last section on the page ("Submit Donations Here") and click the "Donate" button under the fund you prefer. This
    - Click the "Proceed to Checkout" button in the Shopping Cart window. A PayPal page will appear. It is not necessary to have a PayPal account - you simply enter your contact and credit card information to complete the transaction.

I. Please Complete the Membership Form:

(* = required entry)

* Name (First/MI/Last): 

Credentials (OT, OTA, MS, etc.): 

* Membership Type: New Renewal

* Your Email Address: 

* Birthdate (used to create your unique MOTA Membership Number):

Month:     Day: 

* Home Street Address:

* City, State, Zip:

* Home Phone:

Employer:

City, State:

Work/Other Phone:

Fax:

* Membership Dues Category:

* Payment Method:

Student Information:
School: Year of Graduation:

Dual State OT Assoc. Membership Information:
State: Membership Number (if applicable):

PARTICIPATION:
The association depends on its membership to run. Please select the area where you could help:

 Annual Conference
 Legislative Affairs
 Legislative Reception
 Membership
 Fund-raising
 Hospitality
 Newsletter
 Website
 OTA Networking
 Student Support
 Special Events
 Other:

AREAS OF EXPERTISE (please select up to 3):

Administration and Management
 Assistive Technology
Clinical Education
 Developmental Disabilities
 Environmental Modifications
 Gerontology
 Hand Therapy
 Home Health
 Mental Health
 Pediatrics
 Physical Disabilities
 Private Practice
 Public & Community Health
 Research
 School Systems
 Work Hardening
 Other/Special Interests:

WHERE DO YOU MAINLY WORK?
AOTA
 College/University
 Government Agency/Military
 Hospital
 Home Visits
 Private Practice
 Nursing Facility
 Out-Patient Clinic
 School System
 Other:

DISTRICT AREA:
Which MOTA District should we place you in for networking purposes?

PRIVATE CLIENTS:

If an individual is seeking therapy, would you like to be listed as a provider that accepts private clients/referrals? Yes No

MOTA DIRECTORY OPT-OUT:

Please do NOT list me in the MOTA directory (available to all members)

COMMENTS/QUESTIONS/OTHER INFO:
(We are always interested in hearing how we can best serve our membership.
Please feel free to add your comments or suggestions here)


 

THANK YOU!

II. Please Pay for Your Membership:

1. Type of Membership Form Submitted - 

Please Note: You MUST send in a Membership Form!

2. Select Your Membership Category - 

Please Note: You MUST send in a Membership Form!

3. Select New/Renewal - 

4. Pay - 

              

III. Submit Donations Here:
(unfortunately, in order to enter a set amount these must be done separately, both from the membership payment cart and from each other)

MOTA SCHOLARSHIP FUND:

MOTA LEGISLATIVE FUND:

MOTA Homepage Contact MOTA
Membership Info. / Employment Opportunities / Continuing Ed. Opportunities
Organizational Structure / Consumer Info. / Current Newsletter / Advertising Info.

©2010 Maryland Occupational Therapy Association
(Last Updated: December 31, 2009)