NER-AMTA's Membership Support/Pay It Forward Application
Please fill out the following form to complete your submission for the NER-AMTA's Membership Support/Pay It Forward Application.

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Email *
Where do you live in the New England region? *
Additional Credentials
Have you ever been an AMTA member in the past? *
If yes, how many years ago?
What is your current employment status? *
How many hours a week are you working as a music therapist?
Please check the amount YOU are able to contribute towards the cost of your membership. *
The full cost of professional membership is $250.
If you are a first or second year professional, please confirm you have requested your Welcome to the Profession Intern Packet from AMTA. *
If you do not have a Welcome to the Profession Intern Packet from AMTA, you can request one here:
 If you have check yes, what is the amount of your coupon that will be applied to this year's membership fee?
How can you pay your membership forward in a non-financial way? *
Please check two ways to "Pay it Forward".
Please identify one person to whom the Committee can contact as a personal or professional reference. Include the person's:  1) Name 2) Email address  3) Telephone number. *
Please write in paragraph form.
Why do you want to be a member of the NER and AMTA? *
What do you want to get out of being a member? *
How will being a member impact your professional life or your work in the field? *
Is there anything else you would like mention? *
The Committee asks that each award recipient complete their pay-it-forward task(s) and submit a short summary by December 5, 2021. These short summaries are to be emailed to Mark Fuller at: This will help us gather feedback, add new ideas to how other MT-BCs can Pay It Forward in future years, and support the continuation of this new program. Do you agree to this? *
Names of recipients of Pay It Forward grants must be shared with AMTA in NER’s annual 990 report for tax purposes. Do you agree to this? *
NER-AMTA cannot guarantee anonymity after the blind review process is complete and grant decisions are finalized. Do you agree to this? *
A copy of your responses will be emailed to the address you provided.
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