Membership Application

Should you wish to join MTA, please complete the MEMBERSHIP REQUEST  below and click "Submit".

Please do not send any payment at this stage.

Once your request for membership has been processed the MTA secretary will contact with you with further information and a detailed account of fees due.

Membership Application Type:

Full Membership Student Membership Associate Membership

Personal Details:

Title:
Name:
Surname:
ID No.:
Date of Birth:
Sex:	Male Female
Postal Address:
Code:
Residential Address:
Code:
Place of Employment:

Home Tel:
Work Tel:
Fax:
Cell:
E-mail:

Practice Details:

Allied Health Professional Council of South Africa - Registration No.:

Name of Training Institution:

Address of Institution:

Tel:

Principal and/or Trainer's Name:

Date Qualified:

I currently practice:

Full Time Part Time

Period in Practice:

Study Details:

Allied Health Professional Council of South Africa - Registration No.:

Name of Training Institution:

Address of Institution:

Tel:

Principal and/or Trainer's Name:

Date Training Commenced:

Completion Date:

By submitting this form I hereby apply for membership to the Massage Therapy Association and declare that all the information I have given in this form is true and correct.