BCTTNS Annual Membership Renewal

Date: ______________________

Name:________________________________________ Membership #_______________

Address:_________________________________________________________________

E-mail ______________________ Phone # ___________________ Phone # ____________________

Do you belong to a TT PRACTICE GROUP (Yes / No )?

If Yes,

LOCATION:_____________________________________________________________

 FACILITATOR:   ________________________________________________________

Are you a qualified TT RECOGNIZED PRACTITIONER (TTRP )? __________ Year: ______

Other qualifications DEGREES / LICENCES :

________________________________________________________________________________

________________________________________________________________________________

THERAPEUTIC TOUCH STUDIES (Krieger-Kunz method) taken in the past year.

( Date - Course-Hours- Instructor - Location)

________________________________________________________________________________

________________________________________________________________________________

I am Interested in VOLUNTEERING (check applicable ) :

I would give TT sessions through BCTTN referral services at these locations

( this section applies to people with Level 3 or above e.g. TT Recognised Practitioner)

I give my permission to share my name/address with TT network members: YES    NO

Mail 1) completed registration form, 2) cheque payable to BCTTN,

Membership Coordinator:

Dianne Whetstone
5178 Jeffries Rd.
Duncan,  BC  V9L 6S8

250-748-6073
email: dwhtstn@gmail.com