Name:

Name and location of clinic (including suburb):

Main phone number:

Mobile phone number:

Email address:

I would like my e-mail listed on the website under my entry:
Yes No

Website:

Photo (upload file):

Modalities offered:

Qualifications:

Practising massage professionally since

Comments (about your work, clinic etc.):

Current MNZ membership status:
Not a member Certified Massage Therapist (CMT) Remedial Massage Therapist (RMT)

Membership of any other professional organisation(s):

Fees (e.g. 60 minutes = $60)

Payment options that you can accept:
Cash
Cheque
EFTPOS
Credit cards

Secondary work address (if any):

Phone number at this address:

Tick the following boxes for the items you have sent:
electronic copy of qualifications
photocopy of qualifications
pictures (yourself, clininc etc.)
a cheque
a virtual cheque into WESTPAC account
 

Please put me on your "KEEPING TRACK" mailing list (a free e-mail newsletter for massage therapists):
Yes No

Please enter in the word you see below:

By submitting this form I agree to the terms and conditions