International Register of Wellness Practitioners

Membership Form

You may submit this form if given consent to pay with PayPal, otherwise print out and mail it with appropriate payment.

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Administrative Office

3419 Woodstock Road, Suite 6, Fredericton, New Brunswick, Canada E3E 1A5

Tel: (506) 206-3195

www.irpw.webs.com

Membership Application Form

Please circle the membership that you are applying for:

Professional Member, Initial Application $125.00

Professional Member, annual renewal $90.00

Non-Practicing, Professional Member, Initial Application $100.00

Non-Practicing Professional Member, annual renewal $80.00

Professional Instructor Membership, Initial Application $225.00

Professional Instructor Membership, annual renewal $145.00

Student Member, Initial Application $85.00

Student Member, annual renewal $65.00

Associate Member, Initial Application $75.00

Associate Member, annual renewal $55.00

For each modality over one, add $15.00

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Please supply the following information:

Name: Business Name:

Address:

Bus. Phone#: Home Phone#:

Fax #: E-Mail:

Modality registering: (if more than one modality, please include $15.00 for each modality over the first)

Please make Certified Cheques or Money Orders payable to 7134495 Canada Inc. (IRWP)

Form of payment enclosed:

Cheque (certified) Number__________________ Canadian Funds Only

Amount: ____________________

Money Order No.______________ Canadian Funds Only

Amount: _____________________

PayPal confirmation Number:____________________

Amount: _____________________

I hereby agree to adhere to the International Register of Wellness Practitioners Code of Ethics

__________________________________(name printed)

http://irwp.webs.com/codeofethics.htm

Signature:

Professional Members and Professional Instructors only please include copies of the following information:

Certification for Wellness course of at least 200 hours

Exam certificate, or Certified copy of Diploma/Certificate/Degree

Certified Copy of transcripts

First Aid/CPR certificate

Copy of E & O (liability) insurance.

If you are unsure of documentation, send your package into the Register and we will let you know what else you need. For renewing professionals, please include your registration number with us, and copies of your current E & O insurance, First Aid/CPR certificate. Renewals will not be available unless these are current.

Student Members please include the following:

Name of School:

Address:

Web address (if available)

Phone Number:

Student Number (if applicable):

Name of Teacher:

Name of Course:

Number of Hours of Course:

All payments are to be forwarded in Canadian funds only. Cheques MUST be certified and can ONLY be drawn on a Canadian Bank.

Paperwork will be processed once payments have cleared the banking system, usually ten business days.

If you do not have a Canadian Bank account, please send a Personal Money Order (in Canadian Funds only please), or call and make arrangements for a PayPal transfer.

PayPal transfers are a secure way of making your payment, and you receive a receipt of your payment immediately. PayPal transfers can be made in ANY currency, your payment is exchanged at the rate of the day automatically to Canadian funds and forwarded to us.

DO NOT MAKE A PAYMENT THROUGH PayPal WITHOUT AUTHORIZATION FROM IRWP.

Please allow 6-8 weeks to receive your package in the mail with your Registration number and certificates (if applicable).

Complete and accurate applications secure prompt return of documentation, please complete application in BLOCK CAPITALS when printing. DO NOT SEND ORIGINAL DOCUMENTS, HAVE THEM PHOTOCOPIED AND CERTIFIED! These documents will not be returned!

Welcome to the International Registry of Wellness Practitioners!