MEMBERSHIP RENEWALS

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MEMBERSHIP RENEWAL FORM
Please complete all fields so that we have your most up-to-date details.
Dateof appointment
Title Mr/Mrs/Ms/Dryour full name
First Namefirst name
Last Nameyour full name
Address Line1your full name
Address Line2your full name
Suburbyour full name
Postcodeyour full name
Home Phoneyour full name
Mobileyour full name
Website Addressyour full name
How would you like to receive renewal notices?pick one!
PART A: Membership Level
Practising full registration. Tick the appropriate level of membership, then go to Part B.Membership levels Below
Non-Practising Registration. Tick the appropriate level of membership, then go to Part B.Membership levels Below
ARE YOU UPGRADING YOUR MEMBERSHIP?If so, you will be asked to upload supporting documents
PART B: Payment Options
PLEASE SELECT WHICH PAYMENT OPTION YOU HAVE CHOSENFor EFT Payments please use these details: ASCH at Commonwealth Bank, BSB 062 161, Account No. 10025391. Please write your name in the reference field so that we can track your payment
Membership Agreement
I, please add full name hereyour full name
hereby apply for membership the Australian Society of Clinical Hypnotherapists (ASCH). If I am accepted, I: 1. agree to abide by the ASCH’s Code of Ethics and any other by-laws promulgated by the ASCH or its Board of Directors from time to time, for as long as I remain a member 2. agree to abide by all applicable State, Territory, and Federal laws 3. understand that, as a member of the ASCH, I have to ascertain for myself whether I require State or Territory permission or approval for the premises in which I work. I
I declare that the information provided in this form is true and accurate in every respect.
Full Nameyour full name
Signedyour full name
Dateof appointment
Fileupload
Upload
FOR MEMBERSHIP UPGRADE - PLEASE UPLOAD YOUR SUPPORTING DOCUMENTS HERE IN ONE FILE PLEASE. ACCEPTED FILES ARE PDF.
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