Occupational Therapists For Christ Serving Christ Through Excellence In Occupational Therapy

Annual Renewal of Membership

(It is important that your interest & information is updated so that we may maintain contact with you by mail or Email)

Name  _______________________  _______________  ____________________________________________
                              First                                 Middle                                 Last Name (Please Print)                         

Street1  _____________________________________  Street2  ______________________________________

City ____________________________  State ______     Zip ______________   Nation ____________________

Phone: Home (______) ______-________    Work (______) ______-________    Fax (______) ______-________

 Email Address _______________________________________   OTR? ______   COTA? ______   Student? ______

I could present a topic at a conference.          Yes ___ No ___

I could write something for the newsletter.     Yes ___ No ___

I would like to meet with local Christian OTs.  Yes ___ No ___

I enclose a check for $__________ to support IOTFC’s goals.

Share my information with other IOTFC members.  Yes ___ No ___

Share my information with other Christian groups. Yes ___ No ___

Annual Membership & Recommitment Application:

I hereby apply for membership with International Occupational Therapists For Christ Inc. I have read and agree with the statement of faith. I also understand the purposes of this association and that its financial needs are met through voluntary contributions. I agree to participate as the Lord allows with my time, talent and treasure.

 Signature (Do Not Print) _____________________________________  Date _______________________

Please return this form and any contribution payable to:

International Occupational Therapists for Christ Inc. (IOTFC)
PO Box 3291
Greenville, NC 27836

Please feel free to indicate how IOTFC may serve you or give other comments.

100% of your contribution goes to IOTFC, none (0%) goes to a soliciting organization. A copy of the official registration (SD-09015) & financial information may be obtained from the Florida Division of Consumer Services by calling, toll-free, 1 (800) 435-7352, within the state of Florida. Registration does not imply endorsement, approval, or recommendation by the state of Florida. Your gifts to IOTFC are tax deductible subject to IRS guidelines for 501 ( C) (3) non-profit organizations. (January 28, 2002)