International Somatic Movement Education & Therapy Association

30 Morgan St.

Holyoke, MA 01040

Voicemail (413) 446-6009

Email info@ismeta.org

Member Organization Application

Please type or print neatly

Name_________________________________________	Date of Application_____________________________
Address_______________________________________ ______________________________________________	Director_______________________________________ Email__________________________________________________
Phone________________________________________	Website_______________________________________
Fax__________________________________________

Please complete this application form and send all of the following

_____$250 application fee for organizations seeking membership with ISMETA

 Payment Enclosed

 I have already paid online

_____$250 Yearly Registration Fee

_____$10 for Certificate of Registry (optional; 8 ½ x 11” formal Certificate of Registry, with Seal)

_____Statement of Purpose (include if your school has already composed this statement) Describe the mission and goals

of your program

_____An Itemized breakdown of your hours relative to the items listed under “Curricular Requirements” in the

Guidelines for ISMETA Approved Training Programs.

_____ Your questions (Please type on an attached sheet any questions or concerns your school may have about the

guidelines. Please include the section number and letter of the particular clause to which you are referring)

_____Copies of your promotional materials

Enclose applicable catalogues, brochures and video tapes (VHS, U.S. or European format) or DVD of your school and/or program

_____Signed and endorsed copy of the ISMETA Code of Ethics