International Association of Healing Professionals

Membership Application

If you are already in the healing professions it’s time to join the

INTERNATIONAL ASSOCIATION OF HEALING PROFESSIONALS

APPLICATION FOR MEMBERSHIP PLEASE PRINT OR TYPE ALL ENTRIES

There are four membership levels. PLEASE CHECK ONE

Level 1 – Associate Membership - $ 97
Level 2 – Professional Membership - $225
Level 3: IAHP Certified Professional Membership - $497
Level 4: Advanced Certified Professional "Membership - First Year Free" Renewal $125 Annually

* ( Go to www.chihealer.com about Advanced Certified Professional Membership)


Name:
	Last First Middle
Home Address:

City/State:
Zip Code:
Home Telephone:
Business Telephone:
Birth date :
Gender:
Place of Birth:
City
State
Country
Citizen or legal resident of what country:
City, State and Country in which you are or will be practicing:
Specialty or Healing Profession (Only applies to Levels 2-4)
Education: (Please list high school, college and any specialized healing training/education) (Only applies to Levels 2-44)
Other professional associations you hold membership in:

Make application and membership fee "payment" of $______ to

I.A.H.P.
40 West 72nd Street #117
New York, NY 10023
212-724-8782

Please include the following with your check, money order, or credit card "payment" :
• current photograph
• copy of all certificates/transcripts from prior seminars/trainings
• certification fee ($25 of your fee is a non-refundable application processing fee).

If paying by credit card, circle one: MC / Visa / Amex Expiration Date:________

e-mail address:_________________ web site:_________________________

I understand that laws vary from state to state and country to country. I understand that being a healing professional does not give me permission to diagnose, treat and prescribe or violate city, state or national
regulations.

____________________
Print Name

____________________ __________________
Signature of Applicant Date

Please send your membership application in hard copy, as we require your signature that you pledge to uphold our Code of Ethics as an IAHP member. You may print and mail the application with your payment to IAHP headquarters (fees and mailing address are included with the application). If you are unable to download the application, submit a Request for Application on-line, and we will send you an application in the mail.

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