Clone of 2025 Membership Application Form Online Payment

Association for Indiana Music Therapy, Inc Membership Form

AIMT is a 501(c)3 nonprofit organization
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Format: (000) 000-0000.
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I grant permission for AIMT to publish my contact information in the membership directory in the Members Only section of the AIMT website. Select all of the following that you give permission to be published.*

NoNameEmailPhonePlace of EmploymentJob TitleWork AddressWork NumberWebsite/Social Media
I would like for my information to be included in the "Contact a Speaker" section of the AIMT website. This is a list of professional MT-BCs available for speaking engagements at facilities and conferences. Your name and contact information would be posted on the "Contact Us" page of the AIMT website.*

YesNo
Topics I would be willing to present for the "Contact a Speaker"
Please recommend topics and ideas for future state conferences (include specific presenter/information):
Would you be interested in presenting at an AIMT state conferences? If so, please list topics.
Would you like AIMT to consider virtual conferences and events?*

Yes - this is helpful to me because I might attend virtuallyYes - this is helpful to others who may want to attend virtuallyNo - this is not necessary
What can AIMT do to better support music therapy in Indiana?
AIMT is always in need of volunteers to serve our purpose. Please check any areas below which you would be willing to assist.

Government Relations/AdvocacyAIMT OfficerPublic RelationsContinuing Ed/ProgrammingMentoring/Professional SupervisionOther
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Association for Indiana Music Therapy, Inc Membership Form

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