Demande d'adhésion

Membership Application Form copy

Personal Information
Your Name(*)

Please let us know your name.
Your Address(*)

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Your City(*)

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Select Your Province(*)

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Your Home Phone(*)

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Your Business Phone

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Your Email(*)

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Your Date of Birth (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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Note! You will be required to pass a written certification exam.
Completion Date (MM-DD-YYYY)(*)

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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 application fee.
Choose Level Of Membership You Are Applying For:

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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 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(*)

En cochant cette case, vous confirmez que les informations sur cette application sont vrais.SVP confirmer que les informations sur cette application sont vrais.
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