Please print out this form and mail or fax it to:
American Music Therapy Association
8455 Colesville Rd, Ste. 1000 • Silver Spring, Maryland 20910 USA
Fax: (301) 589-5175 • Phone: (301) 589-3300 • E-mail:products@musictherapy.org

Check/money orders must be mailed to AMTA.

Product Order Form

Please allow 4 weeks for delivery. All products are available in limited quantities.
A rush fee of $10.00 will be charged for orders needed in less than 4 weeks.

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: _________________________________________ State/Prov: _______________ Zip Code: ____________

Country: ___________________________________________________ Foreign Zip: ______________________

I am paying by:            VISA            MasterCard            Check

I authorize payment for the items listed above:

VISA/MC#: ____________________________________________________ Expiration date: _______/_______

Signature: ____________________________________ Date: ____________ Daytime Phone: (____) __________

Please make checks payable in US funds (must be drawn through a US bank) to: American Music Therapy Association