AZMTA 2019 Membership Form and Website Release
Name (please include credentials) *
Your answer
Select membership type: *
Address (for private use by AZMTA; will not be shared publicly): *
Your answer
Best phone number (for private use by AZMTA; will not be shared publicly): *
Your answer
Email address (for use by AZMTA; will not be shared publicly): *
Your answer
What subject matter would you like to see being presented at our symposium?
Your answer
Would you like to present at a symposium? What subject matter would you like to present?
Your answer
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.)
Your answer
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)
Your answer
Business name (if applicable) - for online directory listing
Your answer
Work phone number - for online directory listing
Your answer
Email - for online directory listing
Your answer
Website - for online directory listing
Your answer
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
Your answer
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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