ASSOCIATION OF OCCUPATIONAL THERAPISTS OF IRELAND

Suite 2.20, Smithfield Business Centre, Distiller’s Building, Smithfield, Dublin 7.

Phone: 01 874 8136E-mail: Web:

Membership Application Form 2014

Membership Year Commences January 1st - fees are not pro-rata.

Please complete all information on this form. Print information clearly.

Section 1: Personal Details

Name:Membership No:______

Contact address:Phone:

Mobile:

Date of Birth:

Emailaddress:(for AOTI communication purposes only)______

Gender: MaleFemale 

Section 2: Work Details(Please tick one box in each section)

Type of WorkLocation of WorkGrade

PhysicalHospitalManager

PsychosocialCommunitySenior

Care of the Older PersonDay CentreStaff Grade

PaediatricDay HospitalSessional

Intellectual DisabilitySchoolClinical Specialist

Primary CareTraining CentrePractice Tutor

Education Private PracticeLecturer

ResearchPrimary CarePrivate Practitioner

ManagementPrivate sectorProfessor

PolicyUniversityPractice Ed. Coordinator

ConsultancyVoluntary agencyStudent

 Seeking employment/on HSE panel

Private Practice

Area of Speciality

Paediatric – developmental, intellectual disability

Accessible accommodation

Education/Management

Medico/Legal assessments/reports

Physical intervention/treatment

Psychosocial/Mental Health

Vocational/Employment

AOTI members wishing to be listed on the AOTI website as a Private Practitioner must:

  • provide evidence of their public liability/professional indemnity insuranceto the AOTI Officebeforetheir details can be listed on the website
  • read and agree to comply with the AOTI Code of Practice for Occupational Therapists in Private Practice.

Section 3: Qualifications

Qualification: Dip COTB.SC (OT)MSC (OT)H.DipM.SC (other)PhD

University/College:

Date of qualification: ______/______/______

New Members

Applicants joining AOTI as a qualified Occupational Therapist for the first time must complete the section below to authorise AOTI to confirm his/her qualification.

Applicants who qualified outside of the Republic of Ireland must attach a copy of their letter from the Department of Health and Childrenvalidating their qualification to practice in the Republic of Ireland.

“As part of my application for membership of the AOTI I authorise my college to confirm that I was awarded a ______as qualification in Occupational Therapy in the year ______in the name of______.”

College Degree/Diploma Number (if applicable):

Full Name and Address of College:

Section 4: Advisory Groupsand Research

If you are a member of an advisory group or would like to be a member (the relevant group will contact you directly) please tick the relevant box

I am a memberI would like to be a member

National OT Managers Advisory Group

Musculoskeletal Disorders and Chronic Pain Advisory Group

Older Persons Advisory Group

Intellectual Disabilities Advisory Group

Palliative Care & Oncology Advisory Group

Paediatrics Advisory Group

Mental Health Advisory Group

Child & Adolescent Mental Health Advisory Group

Private Practice Advisory Group

Housing Advisory Group

Primary Care Advisory Group

Neurology Advisory Group

If you do not wish to be contacted for research purposes by Occupational Therapists and students, please tick box 

Section 5: Membership

Full - time Practicing Member€175

Part-time Practicing Member (up to 20 hours)€120

Non–practicing (includes unemployed/retired)€70

1st Year Graduate Member/Living Overseas/Northern Ireland€70

Student Member€25

Occupational Therapy Assistant Member€50

Associate Member (interested persons not holding a recognised qualification (in OT) and€70

not following a full time course of training leading to such a qualification)

Should you begin working in the Republic of Ireland between January 1st and December 31st, 2014 you will need to upgrade your membership category.

NOTE:Practicing members are entitled to use the letters MAOTI (Member of the Association of Occupational Therapists of Ireland)

CPD folder: I have received a copy of my CPD folder 

As a member of the Association of Occupational Therapists of Ireland you agree to read and comply with all AOTI publications relating to good practice. These documents are available on the AOTI website.

As a member of the Association of Occupational Therapists of Ireland you agree to abide by the AOTI Code of Ethics and are subject to the AOTI Complaints Policy.

As a member of the Association of Occupational Therapists of Ireland you agree to the terms and conditions of CPD compliance and you are aware that you may be audited by AOTI.

Section 6: 2013 Membership

All members who register/renew by 28th February 2014 are entered into a draw to win an iPad.

Members will receive one additional entry for every new member recommended.A new member is defined as someone who was not a member of AOTI in 2013 and who becomes a fully paid member in 2014. This offer will only be available to members in the Full Practicing and Part-Time Practicing categories of membership.

If applicable, please enter the name of the AOTI member who recommended membership to you.

AOTI Member name:AOTI membership no:

Section 7: Payment

Method of Payment (please circle as appropriate)

Cheque / Bank Draft / PO for AOTI annual membership€______

Payable to: The Association of Occupational Therapists of Ireland.

Signature:Date: