Membership Checkout Membership Information You have selected the Association Member membership level. The price for membership is $99.00 now. Account Information Username Password Show Password Confirm Password Email Address Confirm Email Address Full Name LEAVE THIS BLANK Already have an account? Log in here Application Form Modalities and Membership Acupuncture Aromatherapy Ayurvedic Medicine Breathwork Coach Counselling Herbal Medicine (Western) Homeopathy Healing Therapies (Healers Course) Ka Huna Massage Naturopathy Nutrition Oriental Remedial Therapy Reiki Practitioner Remedial Therapy Sound Therapist Therapeutic Massage Traditional Chinese Herbalism Traditional Chinese Medicine Yoga Teacher Other Modalities May Be Considered Write any additional modalities in here... Provide Details Of Course(s) Completed Course Provider Course Name Qualification Course Completed Date 1. Upload Any Digital Qualifications 2. Upload Any Digital Qualifications 3. Upload Any Digital Qualifications 4 Upload Any Digital Qualifications 5 Upload Any Digital Qualifications Studio/Clinic Information Business Name Address Website Email Phone Period Of Studio/Clinical Practice Modalities (Therapies & Services) Practiced Studio/Practice Logo Other Relevant Information Residential Address Residential Address (Street Address) Residential Address (Address Line 2) Residential Address (City) Residential Address (State / Province) Residential Address (ZIP / Postal Code) Residential Address (Country) Phone Processing...
