MBE 148 / 45 Glenferrie Road
Malvern VIC 3144
Telephone: 03 9525 9625
Facsimile: 03 9507 2316
Email;
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).
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.
o University of Melbourne Master of Music (Therapy) (On Campus)
o University of Melbourne Master of Music (Therapy) (Blended Learning)
o University of Queensland Master of Music (Therapy)
o University of Technology Sydney Graduate Diploma Music Therapy
o University of Technology Sydney Master of Arts in Music Therapy
o 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:
a. We can not accept photocopies (endorsed or otherwise) or copies printed from an electronic source.
b. Do not apply if your final transcript is not available.
Payment Details:
Enclose cheque payable to AMTA Inc or pay by credit card.
MasterCard o VISA o
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 options for how you would like to receive your registration certificate:
o Registration Ceremony
o By mail immediately after the Registration Ceremony. Your certificate will be sent to the address you have given above, unless we are advised otherwise
o Unsure at this stage and would like to be contacted prior to the Registration 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
Membership Declaration
ABN: 11 881 946 262
Non-members – please complete, sign and return with Application for Registration.
Surname / First NameMailing address
Suburb/town
State / Postcode
Phone
Fax
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
MBE 148 / 45 Glenferrie Road
Malvern VIC 3144
AUSTRALIA
Or Email to: