Occupational Therapy Association of Oregon

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Middle Name

Nickname or Badge First Name

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Primary Phone Type *
- Select Primary Phone Type -MobileWorkHome

Secondary Phone

Secondary Phone Type
- Select Secondary Phone Type -MobileWorkHome

Web Page

Referred By

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Address Line 1

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City

State

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Member Type
- Select Member Type -Occupational TherapistOccupational Therapist AssistantOccupational Therapy StudentAssociateRetired Occupational TherapistRetired Occupational Therapist Assistant

Membership Level
- Select Membership Level -PractitionerStudentRetiree

Region
- Specify Your Region -Northwest OregonMid-Willamette ValleySouth Willamette ValleySouthern OregonCentral OregonEastern Oregon

Special Interest Sections
Work & Industry   Productive Aging   Mental Health   Sensory Integration & Processing   Pediatrics   Rehabilitation & Disability   Home & Community   Developmental Disabilities   Academic Education   Retirees   OOTEP (OR OT Emerging Practice)

Volunteer Opportunities
Not At This Time   Leadership (will partner with existing board member)   Conference Committee   Legislative Committee   Membership Committee   Marketing Committee   Helping at events   Fundraising   Mentoring   Presenter at educational event   OT Night Out Side Leader/Support   Other (please specify below)

Other Volunteer Opportunities

Availability
- Specify Your Availability -WeeklyMonthlySpecial eventsWhenever needed

Number of Hours you would like to volunteer

MC Record ID

Registration confirmation will be emailed to you.