ICMT Registration Form

ICMT Registration Form 2016

Join ICMT in 2016!

The Iowa Chapter of Music Therapy has been an active group for over 20 years serving professionals and students throughout the states of Iowa, Nebraska, and South Dakota. The ICMT provides opportunities for music therapists in this region to provide support and stay connected to one another.

2015 Highlights:

• The Empowerment Workshop was held at Wartburg over the summer
• Many members participated in the Task Force Hill Day
• We received a few donations for the Grant Schmeling fund
• We had 46 professionals and 48 students/interns join ICMT!

By joining ICMT in 2016, not only would you be “in the know” about these great details, but your membership dues will provide many morebenefits!

• Conference scholarship opportunities!

• Reduced cost to ICMT-sponsored CMTEs!
• Networking and professional support!
• Yearly financial support to Wartburg College and The University of Iowa!
• Access to the “members” only area of the ICMT website (
• Financial support to advocacy workshops around the state!

Joining ICMT is just $15.00 for the entire year! Interns, undergrads, and non-MT-BC grad students are FREE! Please send in your registration form and dues by December 31, 2015 to ensure your membership for 2015, continued access to the website, and continued place on our mailing list. Current memberships will expire by this date.

Make checks payable to: MAGGIE SCHEPPMANN (INCLUDE “ICMT” IN THE MEMO) Please send forms and dues to:

Maggie Scheppmann, MT-BC

1138 S 46th St

West Des Moines, IA 50265

An e-receipt for your membership dues will be sent along with the 2016 password the website. A hard copy receipt will be sent upon request.

Thank you for your time, and I look forward to hearing from you!

Maggie Scheppmann, MT-BC

ICMT Treasurer/Membership Coordinator

I prefer to receive ICMT-related emails at home work

Please check the boxes for populations you have experience working with in the past year:

Office Use Only

ICMT Registration Form 2016

Abused/Sexually Abused

AIDS

Alzheimer’s/Dementia

Autism Spectrum

Behavioral Disorder

Cancer

Chronic Pain

Comatose

Developmentally Disabled

Dual Diagnosed

Early Childhood

Eating Disorders

Emotionally Disturbed

Forensic

Geriatric/Elderly Persons

Head Injured

Hearing Impaired

Hospice/Terminally Ill

Learning Disabled

Medical/Surgical

Mental Health

Multiply Disabled

Music Education College Students

Music Therapy College Students

Neurologically Impaired

Non-Disabled

Other, please specify:

Parkinson’s Disease

Physically Disabled

Post Traumatic Stress Disorder

Rett’s Syndrome

School Age Population

Speech Impaired

Stroke

Substance Abuse

Visually Impaired

Office Use Only

ICMT Registration Form 2016

Please mail this form and payment to:

Maggie Scheppmann, MT-BC

1138 S 46th St

West Des Moines, IA 50265

Dues are $15.00 for all MT-BCs. Interns, undergrad, and non-MT-BC grad students are FREE.Checks payable to: MAGGIE SCHEPPMANN (INCLUDE “ICMT” IN THE MEMO)

Office Use Only