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APTAWA
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Home
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Forms
> Member Information Update
Member Information Update
Please complete this form to make sure you receive all the benefits your membership affords, including those that relate to your legislative district (based on your home address) and patient referrals (based on your work address). In addition, we send timely and sometimes critical information via email to all members who have given us their email addresses.
If we do not receive updated information from you, we will use the information we currently have listed in our database.
NAME & PROFESSIONAL DESIGNATIONS
First Name
Last Name
Previous Name
Membership Type
PT
PTA
SPT (Student PT)
SPTA (Student PTA)
Professional Designations or Certifications
Please choose as many as apply.
DPT
MPT
MSPT
MA
MS
MPH
DSc
PhD
CCS
ECS
NCS
GCS
OCS
PCS
SCS
WCS
FAPTA
FAAOMPT
Other Designations or Certifications
EMAIL
APTA Washington strives to send out as little email as possible and to make the email we do send out, especially the subject line, as informative as possible.
We will never sell your email address (APTA policy forbids us from doing this anyway). We will only use your email address for chapter business.
Please fill out the address information below and let us know where you would prefer to receive your email from APTA Washington and what type of email you would like to receive.
Business Email Preferred
Personal Email Preferred
Business Email
Personal Email
Email Preferences
Please let us know if you
DO NOT
want to receive email about the following subjects or if you
DO NOT
want to receive email from the chapter at all.
Legislative Issues
APTA Washington Conferences and Education
APTA Washington Twice Monthly Email Newsletter
DO NOT send me ANY email from the Chapter
MAILING ADDRESS(ES)
APTA Washington an occasional printed item, like a flyer for our annual conference or a ballot that can't wait until the next Chapter Meeting.
Please fill out the address information below and let us know where you would prefer to receive your U.S. mail from the chapter.
Business Address Preferred
Business Name
Business Address
Business City
Business State
Business Zipcode
Home Address Preferred
Home Address
Home City
Home State
Home Zipcode
Information Release to Third Parties
Please let us know if you
DO NOT
want to have your information included in the mailing list rentals that are available for purchase by third-party vendors and advertisers. Purchasers will only receive your name and preferred mailing address. We will not provide your email address or phone numbers.
Please DO NOT release my mailing address to third parties.
Submit