2019-2020 OTAH Membership Application
Vision Statement:
The vision of the Occupational Therapy Association of Hawaii is to be a well respected organization committed to providing educational opportunities, legislative and advocacy networks to its members.

Mission Statement:
The mission of the Occupational Therapy Association of Hawaii is to promote the advancement of the practice of occupational therapy and to serve as an advocate for our members and consumers in Hawaii.

Email address *
Name *
First and last name
Your answer
Phone number *
Your answer
Employer *
Your answer
Work Address *
Your answer
Home Address *
Your answer
Phone Number *
Your answer
Membership Type *
Required
Political Action Contribution
If you would like to make a contribution towards OTAH's political action campaign, please specify the amount. Payment will be billed separately from your membership dues or write a check to OTAH PAC.
I would like to donate the following amount to OTAH's PAC
Your answer
Payment Options *
PayPal Email Address (write n/a if paying by check) *
Your answer
Are you interested in volunteering for OTAH? *
Areas that you're interested in volunteering for:
Need more information?
For additional information, contact Jeannette at (808)949-0451 or jingu@hawaii.rr.com
*OTAH has gone GREEN! Your returned check or PayPal statement will indicate if we received your payment.
Please note the following:
**NOTE: OTAH membership year is from July 1, 2018 to June 30, 2019. OTR and COTA OTAH members have voting privileges, and may hold any office or chair a committee. Student members are eligible to vote and serve on a committee, but unable to hold an elected position. Associate members may serve on committees and are not eligible to vote. Only 80% of your dues are tax deductible, as 20% is allocated to political action. Contributions to political action are NOT tax deductible.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service