APPLICATION FOR REGISTRATION

This form is to be used by recent graduates of Australian accredited courses only (completed the course within the last 12 months).

Name (please print) / First / Last
Address
Suburb/City
State / Postcode
Daytime phone number
Mobile number
Email address

Is this your permanent mailing address for AMTA correspondence? Yes / No

Please indicate which of the following qualifications you have achieved.

University of Melbourne Master of Music (Therapy) (On Campus)

University of Melbourne Master of Music (Therapy) (Blended Learning)

University of Queensland Master of Music (Therapy)

University of Technology Sydney Graduate Diploma Music Therapy

University of Technology Sydney Master of Arts in Music Therapy

University of Western Sydney Master of Creative Music Therapy

If you have not achieved any of these qualifications, then you can not apply for AMTA membership under this process. Please refer to the website for the appropriate alternative.

Applicants must submit the following with this form:

  1. Registration fee. Please refer to website for current fee.
  2. Verification of your qualification. Include an official original transcript of results. This will be returned to you. Please note:
  3. We cannot accept photocopies (endorsed or otherwise) or copies printed from an electronic source.
  4. Do notapply if your final transcript is not available.

Payment Details:

Enclose cheque payable to AMTA Inc or pay by credit card.

MasterCard VISA 

Card Number: _ _ _ _ / _ _ _ _ _ / _ _ _ _ / _ _ _ _ .

Expiry date: _ _ / _ _ CVV …………….

Amount :$......

Cardholder name......

Cardholder signature...... Date:……………….

Details for presentation of registration certificate

Name to appear on your certificate of registration :………………………………….

Registration certificates will be prepared and presented in the second half of the calendar year at the Registration Ceremony at the AMTA National Conference. Please select from ONE of the following optionsfor how you would like to receive your registration certificate:

Registration Ceremony

By mail immediately afterthe Registration Ceremony. Your certificate will be sent to the address you have given above, unless we are advised otherwise

Unsure at this stage and would like to be contacted prior to theRegistration Ceremony to confirm

Registration application dates

Registration application dates are on the website. Please note there are three set dates for registration applications per year for new graduates from an accredited Australian course.

Applicants are reminded that they must apply for registration within 12 months of course completion, otherwise a different process must be used. Please see the website for information. Go to Memberships and then To apply for membership.

Last updated January 2014

AMTA SecretariatSuite 5, 250 Gore Street Fitzroy, 3065, Victoria, AustraliaTel: 03 9525 9625 I Fax: 03 9416 0636 I Email: mbership Declaration

ABN: 11 881 946 262

Non-members – please complete, sign and return with Application for Registration.

Surname / First Name
Mailing address
Suburb/town
State / Postcode
Phone
Fax
Email
I wish to receive correspondence by email / Yes No

Please sign declaration:

I agree to abide by the rules and constitution, code of ethics and standards of professional conduct of The Australian Music Therapy Association as long as I remain a member of the association.

Signature: ______Date: ______

Please return to:

Australian Music Therapy Association Inc

Suite 5, 250 Gore Street,
Fitzroy, 3065, Victoria
Australia

Or Email to: