Welcome to AMTA - DE Chapter

New Member Questionnaire

Name: ________________________________________________________

Address: ___________________________City: _______________________

(Complete only if address is different from mailing address on file at National Office)

State: ________    Zip Code: __________ E-Mail: ______________________

Home Phone: ___________________ Cell Phone: _____________________

Company Name: ________________________________________________

Company Address: ______________________________________________

Company Phone: _______________________________________________

Modalities: _____________________________________________________

______________________________________________________________

We are all volunteers.  If you would like to help on one or more of the following committees please select your areas of interest.

_____ Public Relations                     _____ Government Relations

_____ Education Events                   _____ Sporting Events

_____ Massage School Visits           _____ Website/Info Management

_____ Newsletter Publishing             _____ Newsletter Articles

_____ National Massage Therapy Awareness Week

Please list any questions you may have and the education courses you would be interested in for CEU’s.

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Thank you for your participation. Welcome again to the DE Chapter of AMTA.

Please return to:        Terri Dalton

                                    905 Devon Drive

Newark, DE  19711

Or send an e-mail:   TADalton5@aol.com

One of our DE Chapter Members will contact you in the near future.

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