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


Membership Type






Professional Designations or Certifications

Please choose as many as apply.

EMAIL

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.

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 PTWA at all.

MAILING ADDRESS(ES)

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.
 
 

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.