MOTA - Online Membership Form and Payments

Online Membership Form and Payments:

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.

To Join/Renew and Pay Online:

PLEASE NOTE: You may need to tell your browser to "allow the active (or blocked) content" (Javascript) on this page before using these forms.

Fill out the membership form below -
- If new or renewing, please include all applicable and required items.
- When finished, click on the "Submit Form" button, which will generate a new page with all the info. you have entered on it, and also send it to our Membership department.
- If you would prefer to fill out and mail in a paper form, you can download one here:
Membership Application (MS Word format)
Membership Application (Adobe Acrobat® format)

Pay for Your Membership -
a. Click on the first drop-down menu and scroll down to select the type of membership form submitted (online or mailed in - so we know what to expect).
b. Click on the second drop-down menu and scroll down to select your membership category.
c. Click on the third drop-down menu and scroll down to select new or renewal.
d. Click on the "Add to Cart" button to start the payment process. Your order will appear in a separate Shopping Cart window, where you can also remove your selection if necessary (just check "Remove" then "Update Cart"). You can always check and/or change what you have with the "View Cart" button.
e. When you are ready to complete your order, just click on the "Checkout" button in the Shopping Cart window. This will take you to the PayPal page where you can login (if you already have an account), or create a new account. However, it is no longer necessary to have an account to pay - you simply enter your contact and credit card information to complete the transaction.

Please Fill In a Membership Form:

(* = required entry)

* Name (First/MI/Last):

Credentials (OT, OTA, MS, etc.):

* Your Email Address:

* Membership Type/Info.: New Renewal

* 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:

Second State Membership Information:
State: Membership Number (if applicable):

I'm interested in helping with:
Conference (Early Fall)
Legislative (Fall-Early Winter)
Membership
Fund-raising
Newsletter
OTA Activities
Other:

Areas of Practice (please select up to 3):
Administration and Management
American Disabilities Act
Clinical Education
Developmental Disabilities
Gerontology
Hand Therapy
Home & Community Health
Mental Health
Pediatrics
Physical Disabilities
Private Practice
Research
School Systems
Sensory Integration
Technology
Visual Perception / Cognitive
Work Program
Other/Special Interests:

* Geographic Area (select 1 - for home or work):

If you take private clients, in what practice area?:

Would you accept referrals through MOTA? Yes No

Comments/Questions/Other Info:

Please Pay for Your Membership:

Submit Donations Here:

MOTA SCHOLARSHIP FUND: MOTA LEGISLATIVE FUND:


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