AZMTA Membership Form and Website Release
Name (please include credentials) *
PoiSelect membership type: *
Address (for private use by AZMTA; will not be shared publicly): *
Best phone number (for private use by AZMTA; will not be shared publicly): *
Email address (for use by AZMTA; will not be shared publicly): *
What subject matter would you like to see being presented at our symposium?
Would you like to present at a symposium? What subject matter would you like to present?
What other events would you like to see AZMTA host? (social events, support groups, peer supervision, groups meetings arranged by area of practice- i.e. mental health, medical, hospice, DDD, etc.)
This year we are going to be sending ALL job listings that come through AZMTA.com via email. Would you like to receive these emails? *
Would you like AZMTA to post your professional/business information in our online directory? If yes is selected, this will authorize AZMTA to post the following information on the AZMTA online music therapist directory for access by the public. *
Name - for online directory listing - (please include title and credentials)
Business name (if applicable) - for online directory listing
Work phone number - for online directory listing
Email - for online directory listing
Website - for online directory listing
Optional, but encouraged- additional information- EXAMPLES- area of the Valley served, populations served, list of services available (i.e. GIM, NMT, NICU, etc.) - for online directory listing
What type of funding do you accept for MT services? (This is a very common question via email). Please list all that apply.
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