Please complete the form below. Please ensure information is accurate as it will be copied into the web pages.
Name*
Name and Location of Clinic (include suburb)
Phone
Mobile Phone
Website
E-mail Address*
E-mail Address (confirm)*
I would like my e-mail listed on the web
Modalities offered
Qualifications (please read text on right)
Practising massage professionally since
Comments (about your work, clinic, etc.)
Current MNZ membership status
Not a memberCertified Massage Therapist (CMT)Remedial Massage Therapist (RMT)
Other professional memberships
Fees (optional; e.g. 60 minutes = $60)
Payment options
Cash Cheque EFTPOS Credit Cards
Tick the following boxes if you have sent .....
an electronic copy of your qualifications a photocopy of your qualifications pictures (optional; yourself, clinic) a cheque a virtual cheque into WESTPAC account
KEEPING_TRACK_ Newsletter
Please put me on your "KEEPING TRACK" mailing list, a free e-mail newsletter for massage therapists
