STUDENT MEMBERSHIP APPLICATION FORM

Details Of The Applicants:

Name in Full(surname first):
Previous Name(if married):
Date of Birth(MM/DD/YYYY):
Permanent Address:
Address For Correspondence:
Telephone No(with STD Code):
E-mail Address:
Name of the Institute where student is enrolled:
Month/Year of admission to Degree in Occupational Therapy:
Academic Year the student is studying on:
Expected Date of Graduating:
Student Photo:
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SUBSCRIPTION & STUDENT MEMBERSHIP POLICIES
(The following informations & regulations has been updated on 1st April, 2017)
(TO BE RETAINED BY THE STUDENT MEMBER)
1. The Student Membership is only for undergraduate students.
2. The STUDENT MEMBERSHIP FEES (w. e. f. from 1st April, 2017) is Rs. 1000/- [inclusive of Application Fee].
a) NRI Student Membership- US $ 40 - inclusive of Application Fee
b) Change of Name in Certificates -Rs 1500 for two Certificates [AIOTA Membership & ACOT Certificate]
c) Duplicate Certificate- Rs.1000 for each Certificate
3.The Student Members are not entit led to voting rights.
4. All students applying for student membership should have their forms signed by the OT School authorit y the applicant is studying along with school seal/stamp.
5. Membership fees will be accepted by Demand Draft only, drawn at any Nationalized Bank, drawn in Favour of ALL INDIA OCCUPATIONAL THERAPISTS’ ASSOCIATION payable in MUMBAI, MAHARASHTRA.
6. Non- receipt of AIOT A Communication should be brought to the notice of Editor IJOT/ Program Head/ Hon. Treasurer immediately.
7. On becoming the Student Member, the member shall receive one Membership Cert ificate and Student Membership Badge.
8. On beco ming the Student Member, one would receive co mplimentary copy of Indian Journal of Occupational Therapy thrice a year and concession in the registration fees in Nat ional OT Conferences or other workshop organized by AIOTA and will be eligible to participate in the scient ific and competitive events at the nat ional conference.
9. Student Membership will facilitate in quick dispensing of Life Membership once the applicant is eligible. The release of Life Membership need not go through the formal approval procedure.
10. No photocopy of the form will be accepted; only original print on A4 size Executive Bond paper will be accepted.
11. The applicant to sign across the affixed photo.
12. Students from AIOTA recognized OT schools can only apply for Student Membership.
13. The filled in Membership Form to be submitted at the Honorary Treasurer’s Office.
14. The duly filled Student Membership Application Form should be enclosed with the Demand Draft of the prescribed amount and one extra passport size photo (45mm X 35mm).
15. 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