Membership Form

By admin

2christine

Please complete the on-line membership form below OR download the 2009-2010 Membership Form here.  Questions about membership can be addressed to our membership chair.

Payment can be made via paypal in the WCMT store or checks can be mailed.  Make check payable to:  Wisconsin Chapter for Music Therapy.  Please send completed paper forms and check payments to our treasurer:

Tiffany Vollrath
2864 Colleen Ct.
Oshkosh, WI 54904

On-line Membership Form (bolded areas are required)

Membership Category
Name
Professional Credentials
Email
Street Address
City
State
Zip Code
Phone Number
Cell Phone
Employer Name
Employer Address
City
State
Zip Code
Facility Phone Number
Facility Fax Number
I grant permission for WCMT to post the above information in a PDF Membership Directory in the member’s only section of the WCMT website.
Grant permission to post your name, city, and e-mail address for the general public in the 'Find A Therapist' section of the WCMT website.
Please list any areas of interest you might have in assisting committee chairs with various short-term projects in the text box below. Government Relations, Public Relations, Continuing Education, Clinical Practices, Newsletter, Membership, or Archives
As a music therapist, are you willing to be a mentor to others?
As a student or intern, I would like to be mentored by a music therapist.
Membership Payment Method
© 2009 Wisconsin Chapter For Music Therapy   l   Email us at info@musictherapywisconsin.org
 facebook