Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Select any of the following options that apply:

Holistic Healer/Health & Wellness
Education & Personal Growth
Intuitive Consultant (Spiritual Counselor, Psychic
Reader)

From the above categories, please list your areas of expertise, the modalities that you practice in order of relevance including courses or training programs you teach. Include your qualifications. (formal education/experiential education)

Do you belong to any other relevant Associations or Organizations? (Please list)

How long have you been practicing as a Holistic Practitioner?

In one sentence, describe the services you offer the public. (What you do.)

In one sentence, describe the greatest benefit your services offer to the public. (What they get.)

Members Listing
This is contact information to be made available to the public. complete only those lines that you wish to appear. That is, if you prefer to list only the organization and not your personal name, then don’t fill in “name” on this portion of the form):

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

WEB OPTION
Please set up a Web Page for my services at an additional fee of $63.00CDN. The URL address will be www.holisticassociation.org/yourname (Email a photo and/or logo as well as up to 500 words describing your offerings and services see a sample on line)

Yes please
No thanks

I agree to the Association of Holistic Practitioners Code of Ethics.

Yes
No

I agree to the Association of Holistic Practitioners Terms and Responsibilities.

Yes
No