DBT Informed Music Therapy Program

Enrollment

Congratulations for enrolling your music therapist(s)

Step 1: Fill Out this Employee Enrollment Form
so we can match your payment with the correct participant and send a confirmation. Fill out this form another time for as many participants as you have.
Step 2: Complete Payment -Secure your therapist’s place in the program.
A payment link will appear once you submit this form.
If your facility requires you to mail a check instead, mail to
The Spiegel Academy, PO Box 954, Paonia, CO 81428
Spots are limited. Payment guarantees enrollment.

First Name of Music Therapist

Last Name of Music Therapist

Email of Music Therapist *

Phone Number of Music Therapist *

I agree to terms & conditions provided by the company. By providing my therapists cell phone number, they agree to receive SMS notifications, reminders, alerts & occasional marketing communication from The Spiegel Academy. Message frequency varies. Message & data rates may apply. (You/they can opt-out by replying STOP at any time.)