Membership Application Form

MEMBERSHIP APPLICATION FORM
Printable application form available here: MRMTA Application

Or apply online by completing the form below:
PERSONAL INFORMATION
Name

First Name Last Name
Email
example@example.com

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Website
Phone/Other/Fax
CONTACT (STUDIO) INFORMATION

If your studio location is different from the address listed above, please complete the following section.
Name

First Name Last Name

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone/Other/Fax
Website
If you wish to have a second address listed on the website there is a surcharge of $25.
Do not show my name or any contact information in the Find a Teacher directory.
I wish to apply for:

Full Membership ($205) Interim Membership ($96) Student Teacher Membership ($40)
(Definitions of these Memberships can be found at Become a Member)
Branch Affiliation (check one):

Southern Manitoba Brandon & Westman Independent (more than 80 km from a branch) Winnipeg & Region
TEACHING EXPERIENCE: Attach supporting material.

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For how many years have you taught? Privately? What Levels? In a Grade School? In a Conservatory? In a University?
EDUCATION: Upload Supporting Materials

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Gr 9 Music Certificate Gr 10 Music Certificate Associate in Performance Associate in Teaching Licentiate Bachelor of Music Bachelor of Education Other Undergraduate Degree Master of Music Doctorate of Music Other Graduate Degree
Pedagogy courses (specify)
Letter of reference from MRMTA member (required by Student Teacher Membership applicants)

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Other
SUBJECT AREAS OF REGISTRATION (Documentation MUST be provided for EACH area in which you wish to be recognized). Please indicate the areas of specialization for which you are both qualified and wish to be recognized by the Manitoba Registered Music Teachers' Association. For upgrade please mark appropriately. (Members cannot be listed or advertise in a subject in which they have not had approval from the Membership Committee).

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Alexander Technique Aural Musicianship Accordion** Bass/Double Bass Bassoon Choral Conducting** Clarinet Guitar Collaborative Piano** Composition Drumming (Tabla, Djembe, Taiko, etc.)** Early Childhood** English Horn Euphonium Flute French Horn Harpsichord Harmony, Counterpoint, Analysis* Harp History Instrumental Conducting** Jazz** Oboe Orchestration Organ (Electronic & Pipe) Percussion Piano Piano Pedagogy** Recorder Saxophone Singing Singing Pedagogy* ** Skype (online) lessons Solfege/Sight Singing Speech Arts and Drama Traveling Teacher Theory: Rudiments Theory: Harmony, Counterpoint, Analysis Timpani** Trombone Trumpet Tuba Viola Viola da Gamba Violin Violoncello
Other (please specify)
I will conduct lessons in the following languages:
* Provide documentation of successful teaching/experience

**Requires registration in at least one other instrument
ADDITIONAL DOCUMENTATION REQUIRED BY ALL APPLICANTS: A COPY OF A RECENT (within the past 3 months) CHILD ABUSE REGISTRY OR CRIMINAL RECORD (VULNERABLE SECTOR) CHECK (https://policeinformationcheck.winnipeg.ca/)

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*

I CERTIFY THAT ALL INFORMATION ENCLOSED IS CORRECT
Signature

Clear
Date

Month Day Year
Date
Application Fee: A Non-refundable fee of $30 payable to MRMTA must be submitted with the completed Application Form (Student Teacher exempt). Payment options are: Send an e-Transfer to treasurer@mrmta.org or complete the PayPal form below. You will be billed the appropriate Membership Level fee upon approval of your application.
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Application Fee $ 30.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00
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MEMBERSHIP APPLICATION FORM

PERSONAL INFORMATION

CONTACT (STUDIO) INFORMATION