ASSOCIATE LIFE MEMBERSHIP APPLICATION FORM

Details Of The Applicants:

Name in Full(surname first):
Date of Birth(MM/DD/YYYY):
Address For Correspondence:
Telephone No(with STD Code):
E-mail Address:

PROFESSIONAL DETAILS

Professional Qualifications:
Professional Qualifications obtained from::

EMPLOYMENT DETAILS:

Name & Address of employing Authority:
Designation:
Telephone no.:
Upload Your Photo:
Upload File:
SUBSCRIPTION & ASSOCIATE LIFE MEMBERSHIP POLICIES
(The following informations & regulations has been updated on 1st April, 2017)
(TO BE RETAINED BY THE MEMBER)

1. Associate membership will be awarded to related professionals other than Occupational Therapists for one financial year only

2. Associate Membership fees is Rs 1500/- (w.e.f. from April 2017).

3. The Associate Member will be allowed to present papers in AIOTA conferences but only in Non-competitive category.

4. The Associate Members will be entitled to three issues of IJOT.

5. The Associate Members will be issued membership card and membership #.

6. The Associate Members will not be allowed to participate in any election procedure of AIOTA.

7. Membership fees will be accepted by Demand Draft only, drawn at any Nationalized Bank, drawn in favor of ALL INDIA OCCUPATIONAL THERAPISTS’ ASSOCIATION payable in AURANGABAD, MAHARASHTRA.

8. The duly filled form along with the DD to be sent to Honorary Treasurer of AIOTA.

9. The for m to be downloaded only on A4 Executive Bond paper and enclose one extra passport size photo (45mm X 35mm).

10. The awarding of Membership is subject to approval of AIOT A.

11. The applicant should attach copies of documents as a proof of the said professional qualifications.

12. Hon. Treasurer’s contact details

Dr. Pratibha M.Vaidya
Hon. Treasurer (AIOTA)
O.T. School & Centre
T.N.Medical College & BYL Nair Ch.Hospital
OPD 21 , M Bldg.
Dr. A.L Nair rd
Mumbai Central
Mumbai 400 008
M:09821536404 (call timing 6pm to 10pm)
Ph(R):91-022-28982208
Official Email id :treasurer@aiota.org
Personal Email id:pmv25@rediffmail.com