THE ASSOCIATION OF OCCUPATIONAL THERAPISTS OF IRELAND

Office 1 & 2, 1st Floor, Haymarket House, Smithfield, Dublin 7

Phone: 01 874 8136E-mail: Web:

Annual Membership Application Form

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

Section 1: Personal Details

Name:AOTI Membership No:______

CORU Registration No:______

Contact address:Phone:

Date of Birth:

Emailaddress:(for AOTI communication purposes only): ______

Gender: MaleFemale 

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

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

For AOTI Private Practitioners website / PDF listing - please supply only information which you wish to appear

Email address:______Phone No:______

Private Practice Address:______

______

______

Section 3: Qualifications

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

University/College:

Date of qualification: ______/______/______

New Members

Applicants joining the AOTI as a qualified Occupational Therapist for the first time must send in proof of their qualification/ proof CORU numbervia post or e-mail. Membership will not be activated until the required proof is received.

Applicants who qualified outside of the Republic of Ireland must provide copy of their letter from the Department of Health and Childrenor CORU validating / recognising their qualification to practice in the Republic of Ireland.

Section 4: Advisory Groups/ Committees

If you are interested in renewing / joining advisory group(s) please:

  • Log into the AOTI-LAPD (LAPD just above login section of website) or your AOTI membership login
  • Select ‘Groups’ tab on the top left side of the page. You will be able to view the full list of Advisory Groups / Committees which operate within AOTI
  • Select ‘Request membership’ button alongside the group(s) you wish to join.

You will then receive immediate notification on how to progress your application further.

Please note membership of advisory group needs to be renewed each year, alongside membership renewal

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€70

MemberLiving 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 your membership type change during the year, 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)

Section 7: Payment

Method of Payment

Cheque / Bank Draft for AOTI annual membership€______

Payable to: The Association of Occupational Therapists of Ireland.

Data Protection:

The AOTIwillmanageyour personal information in accordance with the Data Protection Acts (1988 and 2003). As a membership organisation it isnecessaryfor the AOTIto collate and storecertain personal data relating to each member. Thisinformation currentlyincludesname, addresses, telephone and email contact details,qualifications and, in the case of private practice members, details of professional indemnity insurance. The information you provide will be used and held by the AOTIand will bepart of your membership record. Such data may also contain information with regard to the conduct of the member in carrying out professional duties in accordance with the Codes of Ethics of the AOTI You have a right to request personal data about yourself in writing and to correct the same if it is incomplete or misleading.The AOTI will ensure that your information is held securely.

If required the AOTI may disclosedetails of your membership status, but not any personalinformation to a third party,(Healthcare company, potential employer, public body) and by applying for orrenewing your membership you are giving your consent toAOTIdisclosing that information.

Declaration:

  • As a member of the Association of Occupational Therapists of Ireland you agree to read and comply with all the 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 the AOTI.

Signature:Date: