Registration Form

Registration Form
The Pennsylvania Massage Championship will be held April 13th - 14th, 2024 from 9:00 am to 5:00 pm, at the Academy of Massage Therapy and Bodyworks, 141 East High Street Pottstown, PA 19464. For more information, email the Championship Director at jamfunk@comcast.net, visit our website at PAMassageChampionship.org, or visit our Facebook page.
Participant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Upload a Copy of Your Drivers License*

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Pennsylvania State Massage Therapy License Number
Other State Massage Therapy License Number
MASSAGE MALPRACTICE INSURANCE
If the expiration date is prior to April 13th, 2024, bring a copy of your current/valid insurance with you to check-in. Check-in is at 8:00 am EST.
Upload a copy of your current massage malpractice insurance

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CATEGORIES
Select up to 2 categories that you will compete in. You may change the categories that you declare here anytime prior to 03/30/24. Please see the rules (below) for information on preliminary rounds, the points system, and finals.
Please select up to 2 categories you will participate in:

SwedishWestern Freestyle MassageEastern Freestyle MassageWellness MassageSports
Winners/Prizes:

Gold, silver, and bronze winners will receive medals and certificates in each of the five categories.

Overall Finals Champions: gold, silver, and bronze medals and certificates*
- 1st place/Gold Overall Champion gets a FREE entrance into the World Massage Festival ($400 value) and the American Massage Championship ($250 value) held in Cherokee, NC in July 2024 at the Harrah’s Resort.
- A single double certificate will be produced for those winning in a category and in the finals.
ABOUT YOU!

This information you provide will be published on our website and social media.
Are you physically able to give a massage as well as receive a massage?
Upload a recent headshot of yourself:*

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Where did you graduate from massage school or are currently attending (if student)?
Paste the link to your PERSONAL Facebook profile:
Paste the link to your BUSINESS Facebook profile (if you have one):
Paste link to your business WEBSITE (if applicable):
Number of years licensed and practicing (type "0" if student):
Your Bio:
Include any awards, special certifications. Include why you became a massage therapist.
Why did you want to enter this competition?
What do you hope to gain from this competition?
How did you find out about this championship?
Will you be staying at a hotel?
FINAL DETAILS
By submitting this application, I understand that my registration fee is NON-REFUNDABLE. I furthermore agree to abide by the rules of the championship (printed at the bottom of this form) and any reasonable requests made by the staff or volunteers of the Pennsylvania Massage Championship.*

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I also agree that lectures/classes, preliminary rounds and the final, as well as prize giving will be recorded and used for future marketing on social media and my image may be used in these videos or photos.*

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By my signature below, I certify the information I provided on and in connection with this form is true and correct to the best of my knowledge. I also understand that any false statements or deliberate omissions on this form may subject me from disqualification from the Pennsylvania Massage Championship.*

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Once we determine your eligibility, we will email you payment options within 48 hours of your submission. Registration is closed on 03/31/24.

The entrance fee will be $150 (non-refundable) as an early-bird registration before February 1st, 2024

The entrance fee will be $175 (non-refundable) for standard registration between February 1st, 2024 and March 31st, 2024.

Registration will close March 31st, 2024

All participants must be fully insured with ABMP, AMTA, Massage Magazine, etc. Your own insurance covers both you and the participants you treat during the competition. All participants must be fully insured during the competition and list “Pennsylvania Massage Championship” as an “additional insured”.
Should be Empty:

Registration Form

MASSAGE MALPRACTICE INSURANCE

CATEGORIES

Winners/Prizes:

ABOUT YOU!

FINAL DETAILS