Membership Application Form

Membership Application

Email Address

Application Date*

Pfrimmer Number (from you certificate)*

First Name*

Middle Initial*

Last Name*

Address*

City State Zip*

Phone*

Website Address

I want to be included in all TCPIADMT mailings*

YesNo

Background Information Degrees Obtained

Other Forms of Therapy you Practice including PFRIMMER 2, EQUINE, etc.

Degrees or Fields of Study Currently Pursuing

Talents to offer Association

Special Capacity in which you would like to be used?

Pfrimmer School Attended

Date Graduated

Do you wish to be listed in the printed Directory distributed to TCPIADMT members*

YesNo

Do you wish to be listed in the Directory for Equine, Feline, Canine PDMT?

Those who have taken the course only.

YesNo

Do you wish to be listed on the Pfrimmer Internet Website which is public domain? *

YesNo

If So, Please link pfrimmer.com to my website

Members of (select all that apply)

National Certification

YesNo

Do you agree not to teach Pfrimmer Deep Muscle Therapy unless invited by those in authority?

YesNo

Do you agree to uphold the bylaws set forth by the TCPIADMT?

YesNo

Do you agree to uphold the high standards of professional conduct set forth by the TCPIADMT?

YesNo

I understand that dues are non-refundable if I do not uphold the Bylaws and the High Standards.

YesNo

Before your application can be completed you must complete payment on the payment page.

I give my permission for my website to be linked on Pfrimmer.com

YesNo

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