Massachusetts Chapter Candidate Application and Resume


Seeking position for :

First Name :

Last Name :

Email :

Phone Number :

Address :

City :

State :

Zip :

Place of Employment :

AMTA# :

Years with AMTA :

Years practicing massage :

Massage License # :

Education (List high school, college, graduate school, other courses, certifications, degrees) :

List AMTA Chapter or national offices held and/or committee work (include dates) :

List community or professional experience :

What are your strengths and qualifications for this position? (Include past work experience) :

What do you see yourself contributing to this position?

What is your vision for the Mass. Chapter? (What would you like to see changed or added?) :

Are you able to commit for the enter term of the office?

Are you willing and able to commit the time needed to get the job done?
By entering your name and date in the box below, you're indicating that if you are elected for this office, you are able and agree to serve for the prescribed term of office; that the information provided is accurate and that permission is granted for the verification of that information.

Signature and Date :

AMTA Massachusetts