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Registration

 

Free membership is disabled on this site. Please fill this form in below and attached the appropriate documents for assessment. Once we have assessed the application we will send you the link to pay for the appropriate Membership Level.

 

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WHICH LEVEL OF MEMBERSHIP ARE YOU APPLYING FOR WITH ASCH?
Please Selectpick one!
Our administrator will contact you upon receipt of this form and accompanying documentation
Today's Dateof appointment
Title Mr/Mrs/Ms/Drtitle
First Namefirst name
Last Nameyour full name
Address Line2your full name
Address Line1address 1
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!
RELEVANT EDUCATION AND QUALIFICATIONS
Please submit copies of relevant certificates/diplomas, etc. with this application.
Institutionyour full name
Qualificationsyour full name
Year Achievedyour full name
Documents Suppliedyour full name
Institutionyour full name
Qualificationsyour full name
Year Achievedyour full name
Documents Suppliedyour full name
Institutionyour full name
Institutionyour full name
Qualificationsyour full name
Year Achievedyour full name
Current membership of professional organisations/associations
Organisation Nameyour full name
Current Statusyour full name
Member No.your full name
Organisation Nameyour full name
Current Statusyour full name
Member No.your full name
CODE OF CONDUCT
Please tick ‘yes’ or ‘no’ against each of the following questions. If you answer ‘yes’ to any of the questions, please attach a statement outlining the details, including any findings, court outcomes and/or penalties. Note that the information you provide will be kept confidential, and a ‘yes’ answer to any of the following questions will not necessarily preclude you from membership of the ASCH. Note also that If you answer ‘no’ to any of the following questions and it is found at a later date that you have misled the ASCH, you will be deregistered immediately.
Are there any complaints of professional misconduct currently under investigation or concluded in relation to your current or past positions as a hypnotherapist?
Are you aware of any formal complaints made against you in regard to your practice as a hypnotherapist, or as any other professional, to any professional association, registration board, or government authority, at any time, regardless of such complaint being actioned or regardless of the outcome?
Have you ever been refused entry or admission to a professional association or a registration board because of reports of professional misconduct?
Have you ever been dismissed/deregistered/remanded or had action bought against you from a professional or peak body, association or registration board due to a complaint made against YOU?
Have you been convicted of a criminal offence that involved a gaol sentence, white-collar crime, assault, drugs, child abuse, or sexual offence?
Are you currently under investigation by a government body, State, Territory, or Federal Police?
Have you ever had an application to work with children refused?
I declare that the answers to the above questions are true and accurate in every respect.
Full Nameyour full name
Dateof appointment
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
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PLEASE UPLOAD YOUR SUPPORTING DOCUMENTS HERE IN ONE FILE PLEASE. ACCEPTED FILES ARE PDF.
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