ITRA MEMBERSHIP FORM
Please print this form, enclose the membership fee, and mail it to the address listed below.

I ___________________________________ (please print name and credentials)
hereby agree to serve as a member of the Iowa Therapeutic Recreation Association (ITRA), an affiliate chapter of ATRA that is comprised of a group of Therapeutic Recreation professionals residing in the same geographic area. The chapter promotes quality Therapeutic Recreation services by offering opportunities for involvement at the grassroots level. Although membership in ATRA is encouraged, it is not necessary in order for you to become a member of ITRA. Membership fee is $10.00. A Student membership is available for $5.00.

___________________________________
Signature

Please complete the following:
Employer/Organization _____________________________________

Position ___________________________________________________

Permanent Mailing Address _________________________________

City __________________________ State _____________________

Zip Code ______________________ County ____________________

Work Phone Number________________________________________

Home Phone Number________________________________________

Fax Number ________________________________________________

E-mail Address _____________________________________________

Check here if you are an ATRA member ______

Date membership expires ___________________

Would you be interested in helping with any of the following committees?

Education ______ Membership _____ Networking _____
Newsletter _____ Nominations _____ IPRA Liaison _____
ATRA Liaison _____

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