Date (DD/MM/YY) |
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Name of Applicant |
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Address |
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City |
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ZIP |
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State |
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Phone Number (Home) |
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Phone Number (Office) |
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Email Address |
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Website |
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This application is being submitted as part of an Allied Organization Membership application. |
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Name of the organization |
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Current professional identity
(Example: nurse, occupational therapist,
educator, musician, author, etc) |
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Please describe how you are involved
with/use intentional sound and music in your work. |
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| Please indicate if you have the following: |
Academic degrees or certifications |
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If the answer above is yes, please list your granting institutions or schools. Please provide a reference for any certificates. |
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Professional license |
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Has a professional license or certification that you have earned ever been challenged, suspended or revoked? |
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If “Yes” please explain |
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My Application
- I understand that SAMA may request more information as needed to complete the application process. I recognize
that completing an application is no guarantee of acceptance.
Ethics
- I have read and understand the SAMA Code of Ethics. As a member of SAMA, I agree to fully uphold and abide by
all sections of the Code: the Preamble, Mission Statement, General Principles and Ethical Standards.
- I understand as an Allied Member of SAMA, that my membership may be withdrawn for violation of the SAMA
Ethics Code.
- I understand that SAMA service or trademarks, logo or membership material may only be used by, and/or considered valid
for, professional members in good standing.
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