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> 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
SPT (Student PT)
SPTA (Student PTA)
Professional Designations or Certifications
Please choose as many as apply.
Other Designations or Certifications
PTWA 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 PTWA business.
Please fill out the address information below and let us know where you would prefer to receive your email from PTWA and what type of email you would like to receive.
Business Email Preferred
Personal Email Preferred
Please let us know if you
want to receive email about the following subjects or if you
want to receive email from PTWA at all.
PTWA Conferences and Education
DO NOT send me ANY email from PTWA
PTWA will mail you six printed newsletters per year (January, March, May, July, September and November), as well as an occasional other 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 PTWA.
Business Address Preferred
Home Address Preferred
Information Release to Third Parties
Please let us know if you
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.
208 Rogers St. NW
Olympia, WA 98502
360.352.7290 or 800.554.5569
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