Academy of Orthopaedic Physical Therapy Involvement Form

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* 1. YES! I want to get involved in the Academy of Orthopaedic Physical Therapy! I’m most interested in (check all that apply):

Continuing Education

Finance

Government Affairs

Judicial

Membership

Nominating

Publications

Public Relations

Reimbursement

Technology

Clinical Practice Guidelines

Other (please specify)

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* 2. I am interested in participating/working with the following Special Interest Group(s):

Occupational Health

Foot & Ankle

Pain

Performing Arts

Imaging

Animal Physical Therapy

Orthopaedic Residency/Fellowship

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* 3. What is your preference regarding time commitment during involvement?

Short term project

Long term project

No preference

Other (please specify)

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* 4. Do you have any experience working with committees, task forces or special interest groups? If yes, please list below:

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* 5. Your name:

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* 6. Your APTA ID number:

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* 7. Your Mailing Address:

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* 8. Your email address:

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* 9. Your daytime phone: