Please complete all required fields!

1. New Membership Application Form (for ARCH Accredited Training Applicants applying for ARCH Professional Membership)
   
2. Personal Information (For ARCH use only)
3. First Name(*)
   Please Enter Name
4. Last name
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5. Your Address(*)
   Please Enter Address
6. Username(*)
   Username Already Registered Or Enter Valid Username
7. Your City(*)
   Please Enter City Name
8. Select Province(*)
   AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon TerritoryInvalid Input
9. Postal Code(*)
   Please Enter Postal Code
10. Home Phone(*)
    Phone Number Format (000-000-0000)
11. Email(*)
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12. Verify Email(*)
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13. Password(*)
    Please Enter Password
14. Verify Password(*)
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15. Your Date of Birth (follow hyphen format) (MM-DD-YYYY)(*)
    Please Enter DOB
17.  

1. Name of Training Institute or School(*)
   Please Enter Institute Name
2. Training Information
3. Was the training by accelerated or intensive study?(*)
   YesNoInvalid Input
4. Location(*)
   Please Enter Location
5. Phone(*)
   Phone Number Format (000-000-0000)
6. Total Hours of Training(*)
   Please Enter Hours
7. Total Hours of Supervised Practicum(*)
   Please Enter Supervised Practicum Hours
8. Designation Acquired or Level of Certification(*)
   Please Enter Designation
9. Was the training by extension/home study?(*)
   YesNoInvalid Input
10. Start Date (MM-DD-YYYY)
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11. Completion Date (MM-DD-YYYY)(*)
    Please Enter Completion Date
12. Additional Comments
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13. All Professional Level Members (RHt/RHP, RCH/RCHP, RCCH/RCCHP) must undergo and provide a current Criminal Records Check (CRC) conducted by the police/RCMP in their local area. The cost of the CRC is the responsibility of the applicant. The CRC must include Vulnerable Sector Check.
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14. Professional Liability Insurance (PLI) and Commercial General Liability Insurance (CGL) is a mandatory requirement for all professional level members of ARCH Canada. ARCH Canada has group insurance for members that is recommended. Once competency exam is successfully completed, you will be forwarded the PLI/CGL insurance application.
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15.  

1. For Professional Level Membership Only – Practice Information
2. NOTE: The Following Information Will Be Listed on the ARCH Website.
3. Please ensure you have checked the information carefully as this will show as your listing on the website. If you do not want to have your information listed in the directory please leave blank.
4. Name of Practice
   Please Enter Practice Name
5. Business Phone Number
   Phone Number Format (000-000-0000)
6. Business Fax (optional)
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7. Business email address
   Please Enter Valid Email Address
8. City
   Please Enter City
9. Province of Practice
   AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon TerritoryInvalid Input
10. Business Website URL
    Please Enter Valid Url
11. Areas of Speciality (optional)
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12. Other Areas of Certification (initials only)
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13.  

1. Professional Associations
2. Membership in Other Association/s
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3. Date Joined
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4. Membership Number
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5. Are you a member in "Good Standing?"
   YesNoInvalid Input
6. Has your Professional Membership been suspended/terminated in the past 5 years?
   YesNoInvalid Input
7. Choose Level Of Membership You Are Applying For:
   Registered Hypnotherapist (RHt) - $95 + $25 (CAD) payable now - 25.00 CADRegistered Hypnosis Practitioner (RHP)- $95 + $25 (CAD) payable now - 25.00 CADRegistered Clinical Hypnotherapist (RCH) - $125 + $25 (CAD) payable now - 25.00 CADRegistered Clinical Hypnosis Practitioner (RCHP) - $125 + $25 (CAD) payable now - 25.00 CADRegistered Clinical Counselling Hypnotherapist (RCCH) - $125 + $25 (CAD) payable now - 25.00 CADRegistered Clinical Counselling Hypnosis Practitioner (RCCHP) - $125 + $25 (CAD) payable now - 25.00 CADInvalid Input
9. Amount to be processed by PayPal
   0.00 CAD
11. - 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 and Commercial General 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 unless otherwise stated.

    - 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.
12. I understand that once the membership dues are processed that they are non-refundable.
13. 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.
14. I agree to and understand that non-compliance to the above will render my membership invalid without recourse.
15. 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.
16. (*)
    
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18. Please do not close window after click on send button. PayPal will redirect to ARCH site after payment is completed