New Jersey Association for Music Therapy 2023 Membership Form

New Jersey Association for Music Therapy 2023 Membership Form

Thank you for joining the New Jersey Association for Music Therapy! We are your POINT OF CONNECTION within the New Jersey music therapy community. Join by March 15, 2023 to take advantage of the membership perks including the fall seminar CMTE.
I am*

Renewing my membership from 2022A brand new Member in 2023 or was not a member in 2022
Do you live or work in NJ?

Work/reside in NJOut of state member (Welcome!)
Email*
example@example.com
Name*

First NameLast Name
Credentials*

MT-BC
Please list any other professional organizations to which you belong:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (preferred)*

Area CodePhone Number
As a networking organization NJAMT would like to share your contact information with other NJAMT members. Please indicate your preference.*

I Agree to ShareI Do Not Want to Share
Upload a photo of yourself or your business logo for your profile on the website.

Browse Files

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Select your membership type*

Professional - $25Couples - $35Student - $5Retired - $10Associate/Friend of Music Therapy - $15Affiliate Organization- $30
I would like to donate the following amount (dollars) to NJAMT (100% tax deductable)
Name of Primary Workplace/Business/Private Practice (or write: Student/Associate Member)*
Workplace Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (work)

Area CodePhone Number
If you have your MT-BC, are not currently practicing and in other work, what is your job title. If not applicable, please type N/A.
Student Members- School where you are studying Music Therapy
Student Members- Level of Study; Undergraduate, Graduate, Doctoral
Setting(s) Served (Check all that apply)*

Currently a Student or Associate memberAdult Day CareAdult EducationChild/Adolescent Treatment CenterChildren's Day Care/PreschoolChildren's Hospital or UnitCommunity Based ServiceCommunity Mental Health CenterCorrectional FacilityDay Care/Treatment CenterDrug/Alcohol ProgramEarly Intervention ProgramForensic FacilityGeneral HospitalGeriatric Psychiatric UnitGroup HomeHome Health AgencyHospice/Bereavement ServicesIntermediate Care Facility (ICF/DD)Inpatient Psychiatric UnitLabor/DeliveryMilitary BaseMusic RetailerMusic Therapy Business OwnerOlder adult settings - nursing home/assisted livingOncologyOutpatient ClinicPartial HospitalizationPhysical RehabilitationPrivate Music Therapy AgencySchool (K-12)Self-Employed/Private PracticeSupport GroupsUniversity/CollegeVeteran's AffairsWellness Program/Center
Population(s) served (please check all that apply)*

Currently a Student or Associate memberAIDSAlzheimer's Disease/DementiaAutism Spectrum DisorderBehavioral DisorderBereavement/GriefCancerChildren's Mental HealthChronic PainComatoseDevelopmental DisabilitiesDual Diagnoses (Mental health/Chemical Addiction)Dual Diagnoses (IDD/Mental health)Early ChildhoodEating DisordersForensicHead InjuriesHearing ImpairmentsHospice/Palliative CareLabor/DeliveryLearning DisabilitiesMedical/SurgicalMental HealthMultiple DisabilitiesMusic Therapy College StudentsMusic Education College StudentsNeurological ImpairmentsOlder AdultsParkinsons DiseasePhysical DisabilitiesPost Traumatic Stress DisorderRett SyndromeSchool Age PopulationSpeech ImpairmentsStrokeSubstance Use DisorderSurvivors of Sexual or Gender-Based ViolenceTerminal IllnessTraumaWellness
Primary age groups served

Infants (0 to 3 years)Children (4 to 12 years)Adolescents/Young Adults (13 to 25 years)Adults (26 to 65 years)Older Adults (66+ years)
Are you providing telehealth services in 2023?

YesNo
Are you providing professional supervision?

YesNo
Are you accepting private practice referrals (for services provided in NJ)?

YesNo
If yes, please click to continue now to the Private Practice Referral Registration form. This link will take you to another tab, and you can resume your completion of this form once the Referral Registration is complete.
Legislative District

Find your district information from this link:

https://www.njleg.state.nj.us/district-map
Legislative District of your home address*
Legislative District of your primary work address *
What type of connections are important to you?

Continuing education opportunitiesPrivate practice referralsMentorship (for music therapists who are within two years of having graduated)Information about employment opportunitiesInformation about licensure/government relationsAdvocacy & educating the public about music therapyPeer Support
Skill sets I can contribute to NJAMT:

Being presentSocial media savvyProviding peer supportCopy writing/editingtech/web savvyMarketing experienceOperations experienceHistory/record keepingTalking to others about music therapyMaking phone callsDetailsPatienceIndependent workTeam workVideo/audio editingGraphic DesignOrganizingEmail CorrespondencePublic speakingAdvocacy skills
Tell us where you look for information about NJAMT news, continuing education opportunities, events, employment information, social gatherings, etc.

NJAMT Facebook pageNJAMT Instagram accountMessage to your preferred email addressPhone calls/text to your preferred phone numberSnail mail to your home addressPlease don't send me any information
Thank you and next steps

After submitting, you will be redirected to our Membership Drive page where you will be able to pay for your membership and submit your donation, if choosing to do so. You will receive two follow up emails, one confirming your Membership Form submission and the second providing additional information about connecting to NJAMT through our Members Only section of the NJAMT website.
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New Jersey Association for Music Therapy 2023 Membership Form

Thank you and next steps