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BCTTNS New Member Registration
Date : __________________
Name: _______________________________________________
Address: ______________________________________________
Phone: __________________________ 2nd Phone _________________ Email ____________________________
Do you currently belong to TT practice group? YES NO
If yes your facilitator is : _____________________________________
Please list you
THERAPEUTIC TOUCH STUDIES (Krieger-Kunz method) including retreats:
Date ___________________ Instructor _______________________ Location _______________
Course ___________________________________________ Hours _____________
*
Date ___________________ Instructor _______________________ Location _______________
Course ___________________________________________ Hours _____________
*
Date ___________________ Instructor _______________________ Location _______________
Course ___________________________________________ Hours _____________
*
Date ___________________ Instructor _______________________ Location _______________
Course ___________________________________________ Hours _____________
*
Date ___________________ Instructor _______________________ Location _______________
Course ___________________________________________ Hours _____________
*
Additional qualifications: DEGREES / LICENCES/ TT Recognized Practitioner
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I am Interested in VOLUNTEERING ( check applicable ) :
|
Special Events ______ |
PR _______ |
Education _______ |
Practice Group ___ | Regional Rep___ | Other________ |
I would give TT sessions through BCTTNS referral services at these
locations
( this section applies to people with Level 3 or above e.g. TT Recognized Practitioner)
|
Client's home___ |
My home___ |
My treatment place ____ |
Hospital/Facility____ |
|
Hospital/Facility Name: |
|||
I give my permission to share my name/address with TT network members: YES NO
|
Amount Enclosed: $ __________ |
Receipt y/n)?_________ |
Signature: _______________________ |
Application must also include asigned
Code of Ethics and Conduct form.
Membership Dues : Member - $50 TT
Recognized Practitioner (TTRP) - $60
TT Recognized Teacher (TTRT) - $70 (contact
Education chair for details)
Seniors(60) and first time Students of TT $40.00
Mail 1) cheque payable to BCTTN, 2) completed registration form, and 3) signed code of ethics to the coordinator:
Dianne Whetstone
5178 Jeffries Rd.
Duncan, BC V9L 6S8
250-748-6073
email: dwhtstn@gmail.com
Additional Forms: