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Name: ___________________________________________ |
Date _______________ |
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Address: _________________________________________ |
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City:________________________________ |
Province: _______ |
Postal Code: _________ |
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Telephone: (Home) ____________________ |
(Work) _____________________________ |
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E-mail: ______________________________ |
Fax: _______________________________ |
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HT Level Completed: _____ |
Professional Qualifications: RN o BSN o |
Other___________ |
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| PLEASE CHECK ALL ITEMS THAT APPLY TO YOU | |||
 New Membership |
Renewal |
Member # ________________ | |
| MEMBERSHIP | I WOULD LIKE TO HELP WITH | ||
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GENERAL |
$60.00 | Provincial Rep |
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| Completion of Healing Touch Level 1 is mandatory. Includes newsletter, directory listing, event discounts, voting rights & reduced rate for HTI Membership. | Membership |
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ASSOCIATE |
$45.00 | Newsletter |
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| Supportive membership for groups or individuals - not students in the HT program. Includes newsletter & event discounts. Non-voting No longer available to new members. | Policy |
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| Research |
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NEWSLETTER |
$20.00 | Networking |
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ANGELIC |
$1000 & over | Fundraising |
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LIFETIME |
$5000 | Other |
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Please make your cheque payable
to: |
Healing Touch Association
of Canada Inc. Kim Polvi 4163 Varsity Rd., NW Calgary, AB T3B 2Y5 |
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I authorize my name, address,
telephone number and e-mail to be printed in the Membership Directory
YES NO
and to be shared only with
Healing Touch Canada, The Canadian Healing Touch Foundation and
Healing Touch International.
PLEASE NOTE SIGNATURE
REQUIRED _________________________________
Did you know the Healing Touch
International membership fee is $35 US for
individuals who are members of their National Organizations?