Registration - Music & Memory

MUSIC & MEMORY® REGISTRATION FORM

Welcome!

Tell us more about what you need.(Required)

I’m interested in bringing Music & Memory to our organization.

I'm in need of training. My organization is already certified.

GREAT! Thanks for your interest in Music & Memory certification.

What kind of training are you interested in?(Required)

MUSIC & MEMORY® Certification Training

MUSIC & MEMORY® at Home Training

Thanks!

Are you ready to register you and your team for training, or would you prefer to use this form to get more information about our training?(Required)

I'm ready to register

Actually, I have a few questions. Can someone contact me please?

Sure, no problem.

What’s your email address? Someone will contact you shortly.(Required)

Name(Required)

First Last

Organization Name(Required)

Job Title/Position(Required)

Job Title/Position Other(Required)

Great! Please let us know more about your organization.

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent Organization (if applicable)

Non Profit Business(Required)

Not-for-profit

Business

Type of Organization(Required)

Type of Organization (Other)(Required)

How many individuals does your organization serve?(Required)

Will your organization's certification be funded by a grant?(Required)

Yes

No

Primary Contact Name(Required)

First Last

Job Title/Position(Required)

Job Title/Position (other)(Required)

Email(Required)

Ok, thanks.

Now let’s get back to the training. Each person you register will receive their own unique access to our training.

How would you like you and your team to be trained, live or on demand?(Required)

Live webinar training

On Demand training

Please select desired Certification Training webinar dates or on-demand.(Required)

Attendees(Required)

First Name

Last Name

Title

Email

Use the + sign at the end of each line to add additional attendees.

Once you click 'Submit' a Music & Memory team member will process your registration and email you instructions for accessing your training.

GREAT!

What kind of training are you interested in?(Required)

MUSIC & MEMORY® Certification Training

MUSIC & MEMORY® at Home Training

Not Sure

No problem.

What’s your email address? Someone will contact you shortly.(Required)

SUPER.

Now how would you like to be trained, live or on demand?(Required)

Live webinar training

On demand training

Please select desired Certification Training webinar dates or on-demand.(Required)

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Contact Name(Required)

First Last

Job Title/Position(Required)

Job Title/Position Other(Required)

Email(Required)

Attendees(Required)

First Name

Last Name

Title

Email

Use the + sign at the end of each line to add additional attendees.

Once you click 'Submit' a Music & Memory team member will process your registration and email you instructions for accessing your training.

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MUSIC & MEMORY, 160 FIRST STREET, PO BOX 590 MINEOLA, NY 11501, UNITED STATES CAREQUESTIONS@MUSICANDMEMORY.ORG

About MUSIC & MEMORY®

MUSIC & MEMORY® is a non-profit organization that helps individuals with a wide range of cognitive and physical conditions to engage with the world, ease pain, and reclaim their humanity through the use of personalized music.

By providing access and education, and by creating a network of Music & Memory certified organizations, we aim to make the therapeutic use of personalized music a standard of care throughout the health care industry.

Accountability

We are committed to financial accountability and transparency. Music & Memory has received silver level status at GuideStar. We’re also honored to be part of the Combined Federal Campaign #90590.

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Please select the FREE Guide(s) you would like to receive:*
- Select All
- How to Create a Personalized Playlist for Your Loved One at Home
- Fundraising for MUSIC & MEMORY℠
- How to Run a Successful Donation Drive for MUSIC & MEMORY℠
- Volunteering for MUSIC & MEMORY℠
- Becoming a MUSIC & MEMORY℠ Ambassador
- Making the Case for Personalized Music: A Guide for Care Professionals
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