Formulaire d'adhésion APMQ 21-22 QMTA Membership application

Quebec Music Teachers' Associaion
Official 2022-23 Membership Application Form
E-mail 1*
For QMTA communications
E-mail 2
For students/clients, if different from the above
Salutation*

Mr.Mrs.Ms.Dr.None
Full Name*

Surname (last/family name) Forename (first/given name)
2022-23 — Type of Registration*

APPLICATION for new membership — FIRST-TIME memberRENEWAL of existing memberhip — I WAS a member in 2021-22REINSTATEMENT of past membership — I was a member BEFORE 2021-22

Membership Status*

FULL Membership (Registered Music Teacher).FRIEND of the QMTA (this status is restricted to non-music teachers, retired or inactive music teachers).
Language of Communication*

EnglishFrench
Postal Address*

Apartment/Suite — Civic No.
Street type Street name
Municipality/City Province
Code postal
Primary Phone Nº*
Alternate Phone Nº

Membership Status

FULL membership (Registered Music Teacher)FRIEND of the QMTA (this membership is restricted to non-music teachers, retired or inactive music teachers).
Personal Info Modifications/Additions/Deletions*

NO CHANGES since 2021-22Language of communicatione-Mail addressPostal addressTelephone numberWebsite URL
Please describe modifications/additions/deletions here, if any.

Membership Level & Annual Dues*

$ 145 — Active Member (Registered Music Teacher/full membership)$ 135 — Provisional Member (status conferred by the QMTA to teachers not yet eligible for full membership).$ 50 — Friend of the QMTA (non-teacher)
Payment Method. Payment of annual dues must follow with the form.*

Mail-in cheque, payable to Quebec Music Teachers' Association, 3870 rue Labelle, Saint-Hubert, Quebec, J3Y 7T6Interac® e-Transfer to tresoriere@apmqmta.orgPayPal™. Go to Paypal.me/APMQMTACredit card

Opt-out Options. Check if you wish to UNSUSCRIBE (Remove your name from the list).

CFMTA (Canadian Federation) "Of Note" memo, and "Canadian Music Teacher" magazine.QMTA's webzine "MusiWeb"QMTA's Member-to-Member Program e-mailingsAll e-mail communications from the QMTA, except those in regards to my membership.
Validation*

Please accept my application/renewal/reinstatement as a member of the Quebec Music Teachers' Association, until September 30, 2023. I certify that all information provided in this application is accurate. This constitutes a signature.
Should be Empty:

Quebec Music Teachers' Associaion