Sign Up - Illinois Developmental Therapy Association (IDTA)

	Illinois Developmental Therapy Association P.O. Box 1114 Oswego, IL 60543

Membership Sign Up

Illinois Developmental Therapy Association
P.O. Box 1114 Oswego, IL 60543

MEMBERSHIP APPLICATION FORM
Membership year is one year from the applicant’s sign-up date.

This is truly a "ground-breaking" association! This association is dedicated to the growing discipline of Developmental Therapy. IDTA is working to guide our profession as we move toward accreditation and licensure.

Name (single applicant only):
Job Title:
El Credential # Type:
El Credential Number:
CFC served:
County:
Mailing Address:

City: State: Zip Code:

Contact Number: Example 8159991212 Cell Home Work

Fax Number: Example 8159991212

Email Address:

I allow all the information listed above to be published in the IDTA Directory. Yes No
Student Member Info If you're applying for a student membership please check the following types: Please mail a copy of your current curriculum and/or EI professor letter to the address above. College College Name: DTA Credential Pending
INVOLVEMENT We encourage you to become involved in your professional association. Please indicate below which opportunities you would like to learn more about: Membership Publications Legislative Professional Development Continuing Education Annual Conference Planning Finance