Robert F.

Unkefer Academy of Neurologic Music Therapy

INTERNATIONAL NEUROLOGIC MUSIC THERAPY

TRAINING INSTITUTE REGISTRATION FORM
NOVEMBER 5-8, 2016
CONTACT INFORMATION
Name (as it will appear on your certificate):_____________________________________________________
Name on Receipt (if different than above):
Institutional Affiliations: _________________________________________________________________
Mailing Address: _______________________________________________________________________
Country___________________________________
Phone Number: _________________________________________________________________________
Email Address: _________________________________________________________________________

I consent to the inclusion of my name, location, affiliation and email address, provided above, on the NMT
Academy website registry Yes / No
I consent to the inclusion of my e-mail on the NMT Academy list, and understand that this list will be used
specifically for the purpose of sending the NMT Academy newsletters. Yes / No

REGISTRATION AND PAYMENT

Your registration will be confirmed upon receipt of your registration form.
_____Registration Fee
Please e-mail registration form to:
cthaut@gmail.com
Make checks or money orders payable to:

University of Toronto, Faculty of Music

Memo: NMT Training Nov 2016
and
Send to:
Finance Office
Faculty of Music, Univeristy of Toronto
80 Queens Park Crescent
Toronto, ON, M5S 2C5

Make checks or money orders payable to:

$850.00CAD

Robert F. Unkefer Academy of Neurologic Music Therapy

University of Toronto, Faculty of Music