Membership Application Form

Please complete the following form to send electronically or open and print this form to send my mail.

New Membership Application Form (for non-members)

Personal Information
Your Name(*)

Please let us know your name.
Username(*)

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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(*)

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Your Business Phone

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Your Email(*)

Please let us know your email address.
Verify Email(*)

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Password(*)

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Verify Password(*)

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Your Date of Birth (follow hyphen format) (MM-DD-YYYY)(*)

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Training Information
Name of Training Institute or School(*)

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Location(*)

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Business Phone(*)

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Total Hours of Training(*)

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Total Hours of Supervised Practicum(*)

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Was the training by extension/home study?(*)

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Was the training by accelerated or intensive study?(*)

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Start Date (MM-DD-YYYY)

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Completion Date (MM-DD-YYYY)(*)

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Note! You will be required to pass a written certification exam if non-accredited ARCH Training.

For Professional Level Membership Only
The Following Information Will Be Listed On the ARCH Website.
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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Professional Associations
Membership In Other Association

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Date Joined

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Membership Number

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Are you a member in "Good Standing"

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Has your Professional Membership been suspended/terminated in the past 5 years?

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You will be charged a non-refundable $25.00 application fee
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 complete the Approved Professional Membership Payment.
Amount to be processed by PayPal

0.00 CAD
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.
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.
(*)

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