PROFESSIONAL: $75.00 per year

• Licensed such as M.D., DO., PT, RN,
• Certified practitioners such as Hypnotherapist, HealingTouch Practitioner, Touch for Health Practitioner, etc..

• Anyone concerned about their rights and wishes to be an active participant in their own health care.

• Must show proof they are full time students in some modality.

• These members are liaison (non-voting) members and are limited in what activities they may participate.

All memberships must be approved of the Board of Directors. Applicants must furnish a resumee showing qualifications, a copy of Certifications, license, or a letter of recommendation from sponsor must be attached.

Print out the following application and mail to the address above.

NAME________________________________________________________________

ADDRESS____________________________________________________________

CITY_________________________

STATE_________ ZIP___________

COUNTRY_________________

TELEPHONE __________________________ (HM)___________________________(WK) __________________________(FAX) ____________________________________E-MAIL

MEMBERSHIP LEVEL :
Professional _____ Active______ Student___ Vendor____

MODALITY(IES)____________________________(1st)_________________________(2nd) ____________________________(3rd)

I would like to be considered for Speakers Bureau in _________________area(s). ** Attach resume showing all experience and documentation of qualifications.