Community Sponsor Form | Black Music Therapy Network, Inc.

TAMBAYA TA MMBA

Na gode don sha'awar ku ga Black Music Therapy Network, Inc. Zama memba nan take yana ba da damar zurfafa alaƙa da mutane a mahadar kiɗa da lafiya tsakanin al'ummomin Black. Cibiyoyin zama membobin mutanen asalin Afirka ne ko launin fata a matsayin Baƙar fata. Haɗuwa abu ne mai sauƙi! Cika fam ɗin aikace-aikacen memba na ƙasa, zaɓi shirin ku, kuma ku shiga yau!

Sunan rana

Sunan mahaifa

Imel

Sunan da akafi so

Karin magana

Ƙungiyoyi / Ƙungiyoyi

Adireshin titi

Layin Adireshin Titin 2

Garin

Yanki/jiha/Lardi

Lambar gidan waya / Zip code

Waya

Da fatan za a raba duk abubuwan gano zamantakewa waɗanda ke da mahimmanci a gare ku kuma waɗanda kuke so mu sani.

Idan akwai ƙarin bayani da kuke so mu sani, da fatan za a raba a nan:

Kuna so a jera ku a cikin littafin adireshi na kwararrun jama'a? Idan haka ne, da fatan za a shigar da sunan ku, kowane takaddun shaida, sabis ɗin da aka bayar, da bayanan tuntuɓar ku kamar yadda kuke so su bayyana akan gidan yanar gizon (misali, John Joseph, MA, MT-BC, LPC; Bitar ilimi akan hip-hop a cikin K -12 azuzuwa; johnjoseph@resist.org).

Ta hanyar ƙaddamar da wannan fom, na tabbatar da cewa:

Ni mutum ne dan asalin Afirka da/ko matsayin launin fata a matsayin Baƙar fata.

Na tabbatar da manufar BMTN don tallafawa lafiya da jin daɗin al'ummomin Baƙar fata ta hanyar kiɗa.

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