MTASA MEMBERSHIP APPLICATION FORM

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BECOMING A MTASA MEMBER

Email *

TITLE *

MRS

Name & Surname *

ID NUMBER *

Contact Number *

Type of Membership *

Full Membership: AHPCSA Registered, Practicing as a Therapeutic Massage Therapist

Student: Learners studying a Diploma in Therapeutic Massage Therapy through an AHPCSA accredited institution.

Associate Member: Non-practicing Therapeutic Massage Therapist, or Health Care Practitioner/Therapist with an interest in Massage Therapy

Required

Profession *

AHPCSA or HPCSA Registration Number (If applying as a student member please type "none" below) *

STUDENT MEMBER: Please provide details of your training institution?

STUDENT MEMBER: Student Number

STUDENT MEMBER: What is your year of study?

First year

Second year

Region *

PLACE OF EMPLOYMENT (If applying as a student member please type "none" below) *

PRACTICE ADDRESS (If applying as a student member please type "none" below) *

PRACTICE CONTACT NUMBER (If applying as a student member please type "none" below) *

PRACTICE EMAIL ADDRESS (If applying as a student member please type "none" below) *

I wish to have my practice's contact details appear on the MTASA website: (If applying as a student member please tick "NO") *

Yes

Required

DECLARATION - By clicking on the submit button below:

I WILL CONFIRM ON THIS DATE, THAT I HAVE STUDIED THE MASSAGE THERAPY ASSOCIATION OF SOUTH AFRICA’S CODE OF ETHICS, CONDITIONS OF MEMBERSHIP & CONSTITUTION AND AGREE TO CONDUCT MYSELF ACCORDINGLY. I HEREBY APPLY FOR MEMBERSHIP AND DECLARE THIS INFORMATION TO BE TRUE. Our policy document can be found at: https://mtasa.co.za/wp-content/uploads/2021/05/MTASA-Policy-Document.pdf

Please email to: The Secretary, info@mtasa.co.za, the following documentation (applications will not be processed without the relevant supporting documents):

1. A certified copy of your Council Registration Certificate (FULL MEMBERSHIP)
2. Certified copies of all relevant Certificates and/or Diplomas (FULL MEMBERSHIP)
3. A letter from your school confirming that you are currently studying Therapeutic Massage Therapy(STUDENT MEMBERSHIP)
4. A certified copy of the photograph page of your Identity Document
5. Membership fee plus administration fee – see account details below

Payment Preference: *

Via EFT (please see banking details below)

Via Credit Card (a link will be sent to you from finance@mtasa.co.za)

ACCOUNT FOR NEW MEMBERSHIP FEES FOR 2022

Administration Fee 2022 (new members only) R 200.00
Fees for 2022: R 480.00
Total Due: R 680.00

Student Fee: R200.00
Associate Member: R200.00

Banking Details

BANK - NEDBANK
ACCOUNT Name - MTA (Massage Therapy Association)
Account Number - 2046443497
Branch Code - 198765
Account Type - SAVINGS
REFERENCE - SURNAME/MTAMEM

EMAIL YOUR POP to finance@mtasa.co.za

Members are encouraged to consider the MPI offering via Shackleton Risk Management and Genoa Underwriting Managers.

To find out more, please email Tenielle Kent on medmal@srisk.co.za or call her on 011 784 5373

https://www.shackletonrisk.co.za/

Thank you for your time. This form will automatically generate your details through to MTASA for confirmation of your member application.

Send me a copy of my responses.

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