Music Therapy Association of  Minnesota                      

Membership

To bemcome a member simply copy and paste the following to a Word document and mail to

 

Veronica Jacobson

565 Sandhurst Dr W # 110

Roseville, MN 55113

 

 

                

 

 

Membership Application

 

 

Name __________________________   Credentials ___­_________  CBMT # ____________

 

Home Address____________________________________City________________________Zip___________

 

Home Phone _______________________________ Cell Phone __________________________

 

Email Address _________________________________________________________________

*please note - we will begin using email as a primary means of contacting and informing you of upcoming events, conference registrations, etc.  please make sure this is clearly written to avoid confusion.

 

Work/ School Address _________________________City__________________Zip__________

 

Work/ School Phone ____________________________________ Fax______________________

 

Work Email Address ____________________________________________________________

                                                                                                 

Populations Served:      please choose the category in which you work the most;

there are examples to what falls within each category and if your specific population is not listed please check the category it would fit into and write in after category name

 


 

  1. Geriatrics (long term care, elderly, gerontology)
  2. Hospice
  3. Private Practice
  4. Neurological Impairments (TBI, stroke, Parkinson’s)
  5. Dementia (Alzheimer’s)
  6. Early Childhood
  7. Chemical Health
  8. School Aged (special ed)
  9. Mental Health (adult or adolescent, day treatment
  10. Developmental Disabilities
  11. Rehabilitation

 


 

 

For students:

  1. Augsburg                                                            Expected date of graduation ________________
  2. University of Minnesota                                    Expected date of graduation ________________
  3. Visitor ___________________­­­­­­­­­­­­­­­__________________

                

Choose one:

  1. Professional Member - $25.00 per calendar year  (January 1 – December 31)

    Includes MTAM newsletter, use of the 24-hour Job hotline, membership directory, networking groups per population, reduced prices and invitations to spring and fall conferences

  1. Student Member - $12.00 per calendar year (January 1 – December 31)

 

Send a check payable to MTAM along with this form to:

 Veronica Jacobson

           

565 Sandhurst Dr W # 110

           

Roseville, MN 55113

 

Thank you for joining MTAM for 2008!