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To Join HAQ please print out this application form and when completed forward it with the relative documentation and fee to: The HAQ Secretary, PO Box 2857, Southport, Qld 4215 APPLICATION FOR MEMBERSHIP In support of your application for membership of HAQ, please supply the following information/documentation: • PRINT Name of Organisation ......................................................................................................................................................................... • Professional Association* or Training School* (*Please delete as appropriate) • Copy of certificate of incorporation (if applicable) • Professional code of conduct as required to be signed by your members or students • Membership pre-requisites for Associations – (not applicable to training schools} • Hypnotherapy training courses currently offered by your organisation . Please supply a list of courses with topics covered and classroom hours for each course. • Cheque/Money Order* enclosed $.......... Application fee ($30)* • Membership for current year ($75)* • Cheques payable to ‘Hypnosis Association of Queensland Inc’. * Please only enclose the application fee of $30 with your application. The current annual membership fee is $75.00 which is subject to change. When your application is approved we will invoice you for a pro rata payment. Applicant's name (PRINT) ........................................................................... Signature ................................................................ Date …/……/…...… By signing this page you will be deemed to have agreed to abide by HAQ's published Code of Conduct (Ethics) Name of organisation .................................…………………........................ Position in organisation …………………….................……………..............….. Contact address ……………….....…..………………………………….......….. ........................................................................ ........................ Email address ………………………………....................................….. Web site address .................................................................................... Contact telephone number …(…..) ....................…....………………… |