Membership Form: 2008 *indicates mandatory fields Please select the "Submit" Button when completed * Application for New Membership * Renewal from Last Year * Renewal from Prior to Last Year Yes!  I want to be a member of ONTABA, an affiliate chapter of the Association for Behavior Analysis International (ABA).  I understand that to become a member of ONTABA, I simply return this sheet with my signature, payment of membership fees, and the information requested.  I understand that becoming a member of ONTABA in no way obligates me to join ABA International. Please note that when advertising services (e.g. clinical work, consultation, and workshops), members of ONTABA will refrain from using the ONTABA name and/or logo without expressed written permission of the ONTABA board of directors and a formal written co-sponsorship agreement. * I agree to the above information If new member, where did you hear about ONTABA?  Colleague Mailing Conference/presentation School Workplace Internet/website Other   *First Name *Last Name *Position/Student *Employer/Educational Institution (if student) *Street Address Home Business *City *Province/State *Postal Code/Zip *Preferred Contact Phone Number Fax Number *Preferred Contact Email Address or N/A *Include my membership information in the  2008 Membership Directory Yes No ONTABA Website Yes No *Voting Memberships Costs/Yr. Costs/3year (15% discount) Description Full $30.00 $76.50 Completed a university/college program in a related field and employed utilizing behaviour analysis principles for at least one year. Sustaining $75.00 $191.25 Same as Full membership status, names of Sustaining members will be noted in the ONTABA newsletter. Student $20.00 n/a Registered full-time in a college or university program in a related field. Affiliate $20.00 n/a Do not meet requirements, but interested in supporting ONTABA. *Are you currently a member of ABA International?   Yes No   *Are you interested in becoming a member of ABA International?   Yes No N/A   Education Highest Level Completed If you are a Student, please indicate: Full Time Student/Part Time Student/Continuing Studies/Other *Grad Year Program Title/Name *Educational Institution Current Occupation *You are employed: Full Time Part Time Both N/A *You work in: Public Service Private Practice  Both N/A *Your primary population: Acquired Brain Injury Autism Developmental Disabilities Geriatrics Mental Health Other N/A *Your primary work: Implementing ABA Research in ABA Administration Designing ABA Treatments   Teaching ABA (education) Not related to ABA Supervising ABA Clinicians  Training ABA (mediators) Other N/A *Total number of years implementing ABA: *Must have been implementing ABA for a minimum of 1 year to be eligible for a Full or Sustaining membership. Working with ONTABA Are you interested in participating on any ONTABA Committee?   Yes     No        awards conference elections recruitment membership newsletter public policy website *Payment By Cheque   PayPal ONTABA, Membership Committee c/o Amy Barker, ABI Behaviour Services West Park Healthcare Centre 82 Buttonwood Ave., Toronto , ON , M6M 2J5   When you select the submit button, you will be redirected to the PayPal Form. Thank you for renewing your membership with ONTABA, or for joining for the very first time!