2011-12 Perry Plouffe Scholarship Application

To be eligible, you must:
• Be in good standing with the AMTA-VT
• Be a Professional Member for at least one year
• Must have not been chosen for the scholarship in the past ten years

Complete the Scholarship Application below for the Perry Plouffe Scholarship and email or snail mail it to the AMTA-VT. All applications must be in by December 1, 2011.

Name: *

Phone: *

Email: *

Address: *

City: *

State: *

Zip: *

 

Member #:

Please list volunteer services you have done in the last year:

Please give a reason you would like to attend New England Regional Conference this year:

How long have you been practicing massage?

How long have you been an AMTA member?

 

AGREEMENT

If selected for this scholarship, I herby agree (1) to participate as a volunteer throughout the conference, (2) to attend all classes I have signed up for at the 2012 New England Regional Conference, and (3) write an article for the Vermont Chapter's "Keeping in Touch" newsletter regarding my experiences at the conference (to be submitted to the AMTA-VT Communications Chair by May 15 of the conference year). If I am unable to fulfill the above responsibilities (1,2,3), I agree to reimburse the AMTA-VT for the full amount of the scholarship.

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