MOTA Membership

Join MOTA today! Fill out the form below or download a membership application or contact our business consultant, Rich Helfrich, to receive an application in the mail: rrhelfrich@charter.net (636) 441-4146.

Step 1: Personal Information

Last Name:

First Name:

Home Address:

(Area Code) and Phone Number

City, State and Zip:

E-mail Address:

Employer or School:

(Area Code) and Phone Number

Work Address:

Work Fax:

City, State and Zip:

Current Position:

Specialty:

Member Type:

Renewal New Member

AOTA Member:

Yes No

Earned Degree in Occupational Therapy from:

MO License #:

Check if you wish to exclude your phone number(s) from the directory.

Step 2: Choose the District that you want to join: (NOTE: 1 Area included with membership)

Greater St. Louis (St. Louis & surrounding area)
Mid-Missouri (Columbia area)
Northwest (Kansas City area)

Southwest (Springfield area)
Southcentral (Ozark area)
Southeast (Cape Girardeau)

Step 3: Check if you would like to be involved in:

Finance	Membership	Website
District Activities	Nominating / Awards	Practice Issues
Programs	Scholarships
Government Affairs	Publications

Step 4: Check membership category:

All MOTA membership categories receive quarterly newsletters and a membership directory. The rights and privileges for each membership category are defined in the directory. Conference discounts are granted to all membership categories except “Organizations”.

Occupational Therapist $60.00
Occupational Therapy Assistant $45.00
OT/OTA Student $15.00
New Graduate $15.00
Associate Member (current member – other State) - State $45.00
Organization, Institution, Agency, or Allied Health Professional $150.00
Honorary or Retired Free

Step 5: Fees

1) Membership category fee	$
2) Optional Donation	$
3) Add Lines 1 & 2	TOTAL $
4) Returning Member discount of $5.00 (if you were a MOTA member last year, not applicable to students)	$ ()
5) Referred New Members (deduct $10.00 per OT, OTA, or Associate Member or full fee for 5 new members) (not applicable to students) Name(s)	$ ()
6) Total Lines 4 & 5	$ ()
7) Subtract Line 6 from Line 3 and enter TOTAL AMOUNT DUE	$
Remember your total. After you click the button below you will be sent to a page which will let you make a payment for your registration.

Step 6: Payment

You may pay securely online (after you submit this form) by credit card or e-check

Step 7: MOTA Welcomes Your Comments, Ideas and Feedback.

To improve our organization and to meet the needs of our members, we need your input. Please share your ideas, need, or concerns about MOTA below: