|
MEMBERSHIP FORM - PRINT
OUT, FILL IN & MAIL
or Copy and Paste into email, fill out and send |
| Name ___________________________________________________________________________________
Address
_______________________________________________________________
City ________________________________________ State _____ Zip
_____________ |
| Home Phone # ________________________
Work Phone # _____________________ |
| Cell Phone # ________________________ |
Email ____________________________ |
| Are you a new member?
________________ Renewing Member? _________________ |
| Degree (circle) BA
BS MA MS PhD
Other _______________________________ |
| Art Therapist (circle)
MA ATR ATR-BC |
| School(s) attended: |
| AATA ID # ____________________________ |
Are you employed as an Art Therapist? Please describe the
setting that you work in and the
population you work with. Please include ages and how many hours a
week you work.
Do you have any areas of specialization? Please describe.
Are you interested in having a page about you on the MNATA
website?
Please add here any more information about you and your
work that you have not mentioned above.
Please highlight the membership you are choosing:
| $25.00 Active Professional |
$25.00 Credentialed Professional |
| $15.00 Associate |
$15.00 Student |
| $15.00 Retired |
|
Please send this with your application fee to:
MNATA Membership Chair
P.O. Box 14435
Minneapolis, MN 55414
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