Membership Renewal Form

Renewal Form for Membership

Personal Information
Your Name(*)

Please enter your name.
Is this a new Address?

YesNoInvalid Input
Your Address(*)

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Your City(*)

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Select Your Province(*)

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Postal Code

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Your Home Phone(*)

Phone number format (000-000-0000)
Your Business Phone

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Your Email(*)

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Your Date of Birth (MM-DD-YYYY)(*)

Please Enter DOB

For Professional Level Membership Only
The Following Information Will Be Listed On the ARCH Website.
Is This New Information/Any Changes?

YesNo (You Can Use The Skip Bottom At The Bottom)Invalid Input
Name of Practice

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Client Contact Phone Number

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Business Fax (optional)

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City Location

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Business email address

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Province for Practice

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Business Website

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Areas of Speciality (optional)

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Other Areas of Certification (initials only)

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For Professional Membership Only
Insurance Information
I have Renewed My PLI Through ARCH(*)

YesNoPlease select one field
For Scope 3 Professional Members Only
Insurance Information
I have Renewed My PLI Through Non-ARCH Third Party

YesNoInvalid Input
Date Insurance Will Expire (MM-DD-YYYY)

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Insurance Policy Number

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Name of Insurance Provider

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Note: If your PLI Insurance is not through ARCH Suggested Insurance, you must mail proof of Insurance to ARCH Office by July 31 or your membership will be considered terminated in accordance with the By-Laws of the Association.
For Professional Membership Only Continued Education Hours (CEH) Information
I Have Completed the Required 30 hours of CEH.

YesNoInvalid Input
CEH Details

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Please provide details of your CEHs.
You are not required to send in proof of CEH at this time. Please keep it on file as we may request this later. However, please list the completed CEH under the "Comment Section".

Other Professional Membership Information
List Membership In Other Association(s)

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Date(s) Joined (MM-DD-YYYY, MM-DD-YYYY...)

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Membership Number(s)

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Are you a member in "Good Standing"

YesNoInvalid Input

ARCH Membership Renewal Information
ARCH Membership Number

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Please Issue My Registration Certificate In

EnglishFrenchInvalid Input
All fees paid are not refundable.
Choose Level Of Membership You Are Applying For:

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Amount to be processed by PayPal $25.00 (Application Fee). Once Membership Criteria is met and confirmation received from ARCH, you will be asked to continue to Fees and Payments to select the level of Membership applicable.
Amount to be processed by Paypal

0.00 CAD
If you are paying by cheque please skip the Paypal area and send an email to directormembership@archcanada.ca notifying them that payment will be sent by cheque to 3920 West 17th Vancouver, BC, V6s 1A5
I declare that I have not been convicted of any Criminal Violation that would preclude me from practice as a Hypnotherapist and remove me from "Good Standing" with ARCH.
I understand that my professional membership level is valid only if I carry Professional Liability Insurance that is current and active.
I give permission to ARCH to list my Name, Name & Location of my Practice/Employer, Client Contact Phone Number, Business Email & Business Website on the ARCH Website and contact my Insurance Provider for my PLI information.
I understand that all information in this application, along with subsequent information is placed in my membership records and will be used for purposes of admission, registration, research, alumni and development, and other purposes consistent with the mandate of ARCH. The use of this information will be in compliance with the Freedom of Information and Protection of the Privacy Act of Canada. Any question concerning the collection and use of this information should be directed to the Director of Membership.
I understand that once the membership dues are processed that they are non-refundable.
By submitting this application, I declare that I have read, and am in complete agreement with the Code of Ethics and Standards of Practice of ARCH and support the Goals and Objectives and Mission of the Association.
I agree to and understand that non-compliance to the above will render my membership invalid without recourse.
Signature(*)

By checking this box you are digitally signing this application and confirming the information in this application to be true.Please check box to confirm the information in this application is true.
Comment/Questions/Up-Grades Request Section

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Please type as shown(*)

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Do not use this form to upgrade your Professional Membership Level. Please request renew at your present level and add a note below to request instructions for upgrading. Realize that your membership renewal is not guaranteed, all renewal applications are reviewed and subject to approval by the ARCH Board of Directors.