Myotherapy Association Australia

Membership Application.

Please select your Membership Type*

Membership Period*

Membership Fee

Prorated

Insurance Information

Your membership with Myotherapy Association Australia includes insurance with Guild. This includes $20 million professional indemnity; $20 million public liability & $20 million products liability with Guild Insurance.

Please note that if you are a applying as a Dip. Remedial Massage or Interim member, this insurance covers you only to practice Remedial Massage.

Required Documentation

Certified copy of Driver's License or Passport
First Aid HLTAID003
Course Provider Name
Name of Course
Graduation Date
Certified copy of graduation certification (OR Statement of Attainment, OR Letter of completion from College/University)
Certified copy of extract of academic record

Certified copy of Driver's License or Passport
First Aid HLTAID003
Course Provider Name
Name of Course
Graduation Date
Certified copy of extract of academic record

Certified copy of Driver's License or Passport
First Aid HLTAID003
Course Provider Name
Name of Course
Graduation Date
Certified copy of Remedial Massage qualification (OR Statement of Attainment, OR Letter of completion from College/University)
Certified copy of extract of academic record
Confirmation of enrolment in Bachelor of Myotherapy (OR Adv Dip Myotherapy OR Statutory Declaration declaring intent to enroll within 12 months)

Copy of Driver's License or Passport
Course Provider Name
Name of Course
Expected Graduation Date

Certified copy of Driver's License or Passport

PLEASE NOTE: Some of the listed documents above must be certified or witnessed before they are submitted (Copies to be certified or witnessed must be taken with the originals to a Police Station, Chemist or JP and be stamped and signed as true copies of the original documents).

Personal Details

First Name*

Last Name*

Address*

City/Suburb*

State*

Postcode*

Mobile Phone*

Email*

Date of Birth*

Certified copy of Driver's License or Passport*

First Aid Provider (e.g. Red Cross) - Applied First Aid certification (HLTAID003) is a minimum requirement, which must be updated every 3 years

Expiry Date*

First Aid Certificate*

Qualifications Details

Course Provider Name*

Name of Course*

Graduation Date*

Certified copy of graduation certificate*

(OR Statement of Attainment OR Letter of completion from College/University)

Certified copy of extract of academic record

Student ID/Number

Confirmation of enrolment in Bachelor of Myotherapy*

(OR Adv Dip Myotherapy OR Statutory Declaration declaring intent to enroll within 12 months)

Practice Details

To be placed in the Myotherapy Association Directory and used for health fund provider numbers and referral purposes.

Click the button below to add a Practice

Account Preferences

Account Password*

Repeat Password*

Password must be at least 8 characters long, include at least one number and one uppercase letter.

Show my password

Personal Information Listing Preferences

I wish for my mobile phone to be listed on the website

I wish for my email address to be listed on the website

Insurance Preferences

Do you require a certificate of currency?

Other Massage or Complementary Health Associations

Are you currently a member of another massage or complimentary health association?

Is that membership still current?

Name of Association*

Declarations

I have not been convicted of a criminal offence in Australia or overseas, punishable by a term of imprisonment of 1 year or more.

No disciplinary action has been taken against me by any other professional association resulting in a suspension or cancellation of my membership.

I authorise Myotherapy Association Australia to provide any relevant information about me as it considers appropriate to any relevant health funds or other bodies or associations.

I agree to abide by the Myotherapy Association Australia Code of Ethics, Code of Practice and Rules of Association, copies of which I acknowledge I have read.

I declare that, if my application is successful, Myotherapy Association Australia will deduct the membership funds from my account.

I have never been denied or had cancelled any professional insurance policy by another provider.

I, of , whose signature appears below, declare that to the best of my knowledge I have met the requirements for membership as determined by the Board of Directors and in accordance with Rules of Association.

I further declare that I have not made any misrepresentation in my application for membership, or my membership rights of the Institute. Thereby further I declare that in the event of my application being approved by the Board, I will abide by the Association's Code of Ethics, Code of Practice and Rules of Association.

In regards to Health Funds, I declare that I will abide by their Terms & Conditions as set. I further declare that I have not undertaken, to the best of my knowledge, nor will I undertake any activity which would be detrimental to the Myotherapy Association Australia (formerly MA) or to the Myotherapy profession.

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