Associate Appl, Add new

Designation

1. Personal Information

First Name

Last Name

Password

Address

City

Province

List

Postal Code

format "A9A-9A9"

Home Phone

Date Of Birth

2. Training

Was the training by accelerated or intensive study?

Name Of Training Institute or School

School Location

School Phone

Total Hours of Training

Total Hours of Supervised Practicum

Designation Acquired or Level of Certification

Was the training by extension/home study?

Training Start Date

Completion Date

3. Professional Level Membership ONLY

Name Of Practice

Business Name

Business Phone

Business Email

Business City

Business Website

Province of Practice

Specialty Areas

Other Areas Of Cert

4. Professional Associations

Membership in other Association/s

Date Joined

Membership Number

Are you a member "Good Standing"?

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

5. Insurance

Insurance Company

Insurance Policy No

Hypnotherapy Liability Insurance Coverage

Insurance Policy Expiry

Insurance Pending

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.

Agree

Additional Comments

Level Of Membership

Amount Paypal

Second Amt Paypal

Rsfp Total

Payment Method

Status

Pending Approval

- 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.

- 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. (*)

Agree

Application Date

10/7/2024

Crimrec

Insurance Proof

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