Change Of Address / Name Form

Your Current Member Name
     If you recently had a name change, please give us your new last name:
New Last Name
Name Change Requirement:  Please submit a proof of the name change to the AMMA Office. Please attach a copy of the legal court record such as a marriage license, divorce decree or a court-approved name change document, supporting the name change. If you wish to have a new certificate, please follow the directions of the Replacement of Certificates along with the proof of the name change.
Your AMMA Member Number
Email Address
Confirm Email Address
Home Phone with
Area Code
           YOUR OLD ADDRESS
Street Address
City and State
Zip Code
          YOUR NEW ADDRESS
Street Address
City and State
Zip Code
Questions / Comments

    

 
 

Home  |  Services  |  Join  |  News  |  Education  |  Testing  |  Products  |  Contact  |  AMMA

Copyright © American Medical Massage Association. All Rights Reserved    888-375-7245
 
.