The Association of Asian-American Pacific Islanders in Occupational Therapy (AAPIOT) National Membership Form 2023-2024 
Please complete all required fields below to complete your membership application.  If a field is not applicable, please enter N/A 
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Email *
Select One- Membership Status  *
State your full legal name: *
What is your mailing address (include street, city, state, zip code, country)?
Contact Number 
What are you professional credentials (i.e. OTR/L, OTD, PhD, etc.) (If you are a student, please identify as your field of study- OTA, MSOT, OTD) *
What is your primary area of practice? (Answer this if you are a practitioner)  *
What is your Ethnicity /Country of your Ethnic background?  *
If you are a student, please identify your academic institution (If you are not a student, skip this question) 
What is your gender:
Clear selection
What are your pronouns?
Please select the organization(s) below in which you currently hold an active membership with good standing *
Required
If approved for membership, are you willing to featured in AAPIOT's formal publications? (social media posts, website directory, newsletter, etc.)  *
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