AMT

Title

First name

Last name

Gender

Personal Email

Please upload a recent passport-size photo:

Address

Address 2

Suburb

Australian state

Postcode

Mobile phone

Home phone

Website

DOB

Continuing Professional Development

I confirm I would like to be included in the CPD scheme:

Yes

AMT encourages all members to participate in our CPD scheme. When you maintain your CPD status you are eligible for website referrals.

It is a legal requirement to do continuing professional development to be able to be recognised as a provider with Private Health Funds

Would you like to receive regular news and important updates via email?

Yes

Would you like to receive regular news and important updates via sms?

Yes

Would you like to subscribe to the AMT Blog?

Yes

I wish to have insurance information sent to me. (If you select yes, we will arrange to have insurance policy information sent to you when your membership is approved).

Yes

First Aid Expires On

Evidence

File Description

Police Check Expires On

Please do not upload the following checks Working with Children (WWCC), Working with Vulnerable People (WWVR) or Aged Care, we do not require a copies of these checks.

Police Check Evidence

File Description

Referral source

Referral source other

Join reason

Join reason other

Mobile Visits?

Yes

Year Completed Qualification

Rto

Rto other

Course

Other course name

Qualification Evidence

File Description

Did you obtain your qualification through partial or full Recognition of Prior Learning?

Yes

Please note AMT may request additional information and documentation for qualifications obtained via RPL

Other Association Proof

Other association provider

List three (3) character referees (name and telephone number) from persons other than family who have known you for the last two years

Referee Name

Phone

Referee Name

Phone

Referee Name

Phone

Membership Level

Level

Fitness to Practice

Have you been the subject of any formal complaints or investigations over the past 12 months that would affect your fitness to practice as a massage therapist?

Have you been the subject of any disciplinary, legal or criminal proceedings over the past 12 months that would affect your fitness to practice as a massage therapist?

If you answered yes to either of these questions, please email a written explanation to info@amt.org.au

Declaration Statements

I have reviewed the standards in the AMT Code of Practice, and will abide by the AMT Code of Practice, the AMT Code of Ethics and any other applicable codes and regulations

I declare that the information given on this form is true and correct.
I understand that:

I must pay all my subscriptions and other monies due until I resign my membership
I declare that I will abide by the AMT Code of Ethics and any applicable rules, codes and regulations
I declare that I will abide by all applicable health fund provider terms and conditions

I declare that the information given on this form is true and correct.

Yes

Application Fee. This is a non-refundable fee, which must be sent with your Application :

$85.00

Payment Details:

Name on Credit Card

Cancel

New Member Registration

Continuing Professional Development

Membership Level

Fitness to Practice

Declaration Statements