Membership Application

Your Name

Your Organisation Name (if applicable)

Your Email

Membership Type

I have read and understand the Code of Ethics and agree to adhere to its terms:

 I Agree I Disagree

I declare that I meet the Membership Requirements and am willing to pay the Membership Fees associated with my level of membership:

 Yes No

What is the full address of where you or your organisation is located?

What is your website(s) address? (if applicable, comma separate)

What qualifications/certifications do you have, and where did you obtain these qualifications/certifications from? (provide names of institutions, locations, contact details and website addresses if possible)

Are you a member of any association, guild, college or other body? If so, which ones? (provide locations, contact details and website addresses if possible)

Why do you want to join the International Hypnosis Association?

I hereby declare that all the above information is true and correct. I also declare that if I am representing an organisation, I have the rights to represent the organisation and act on its behalf. I make this declaration by typing my full name below:

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