Music Therapy Association of Georgia
2018-2019 Membership Form
Name *
Professional or Student? *
Required
University
Address
City, State, Zip
Telephone
Email Address *
Are you a member of AMTA? *
(Professional Members that are not AMTA members must pay the $20 Friends of MTAG fee)
Required
Place of Employment
(Professional Members that are not AMTA members must pay the $20 Friends of MTAG fee)
Private Practice
Employee Address
Employee City, State, Zip
Employee Telephone
Populations Served
Employee Website
May we include your contact information in the MTAG directory (distributed to members only)? *
Required
Yes, I understand I will receive future correspondence via e-mail. *
Required
I am interested in helping with the following committees:
Membership Type *
The current membership begins on September 1, 2018 and ends on August 31, 2019.
Required
Please make checks payable to Music Therapy Association of Georgia (MTAG)
Mail your check to: Emily Minkow, LPMT, MT-BC at 1050 Lenox Park Blvd NE, Apt.# 12304, Brookhaven, GA 30319
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