National Association for Holistic Aromatherapy Membership Application

Please Print or Type. Incomplete forms will delay processing of application.
Name:______________________________________________________________________ Business Name:______________________________________________________________ Mailing Address:______________________________________________________________ City:_______________________________ State: _________ Zip:______________ Email:______________________________________________________________________ Website: ____________________________________________________________________ Contact Numbers: Please indicate by marking an ‘X’ next to numbers available to the public. Home: ____________________________Public: ____ Business: _________________________Public:____ Mobile: ___________________________ Public: ____ Fax: ______________________________Public:____

I am a Licensed Practitioner: (Check each applicable profession)
___Acupuncturist ___Massage Therapist ___Medical Doctor ___Naturopath ___Nurse ___Other: _________________________

*****I Was Referred By: ___________________________________________________

Memberships: Business applicants must submit typed description of business along with
website details. Professional member applicants must submit a copy of applicable aromatherapy certificates/training for NAHA review. All applications (except Friend membership) are subject to review and acceptance. We will notify you if we need further details or have questions about your application. If for any reason your application is not approved and you have prepaid through paypal, we will refund all money immediately.

___New Membership ___Renewal ___Upgrade ___Change/Addition of info. only Membership Type: ______ Friend: $50 • International: $75 ______ Professional: $125 • International: $155 ______ Business: $150 • International: $180 ______ Donor: $250 • International: $300 ______ Grand Donor: $1000 or more

NOTE:
Professional Member Applicants:
I understand that my membership will only

become valid after I mail, email, or fax the following requirements: • Have attended and graduated from Aromatherapy Training Program, minimum 200 hours: You must submit either a certificate from school or transcripts that reflect successful completion of training requirements for Level Two Certification. or Have proof of 4 years direct experience and education in the theory and practice of aromatherapy. You must submit documentation of experience over 4 years as well as education received during that time period. or Have successfully passed the ARC National Exam. You must submit certificate of successful completion of ARC exam. • Complete and mail/fax or email your membership application. • Description of your professional aromatherapy practice must accompany the NAHA Membership Application

All Professional applications are subject to review and acceptance. We will notify you if we need further details or have questions about your application. If for any reason your application is not approved and you have prepaid through paypal, we will refund all money immediately.

Business Member Applications:
I understand that my membership will only become valid after I mail, email, or fax the following requirements: A typed description of business along with website details.

All Professional applications are subject to review and acceptance. We will notify you if we need further details or have questions about your application. If for any reason your application is not approved and you have prepaid through paypal, we will refund all money immediately.

All Members:
• I agree that I do not apply or promote any techniques considered to be unsafe use of essential oils which includes: RDT and other undiluted 'oil drop' techniques, or anything out of my scope of practice. • I have read NAHA’s Code of Ethics and agree to abide by them.

Required Member Signature: (required) ___________________________ Date: _________________ By signing this application form, you agree to the NAHA Membership Guidelines and Requirements as outlined on the NAHA website.

Payment Method: To pay for your membership, you can either use our paypal system or send in check with your membership application and all accompanying requirements, if indicated for your type of membership.

Check #:________ Amount:____________ **A $25.00 fee applies for NSF/Returned cheques For Credit Card Orders, Please use Paypal at: http://worldofaromatherapy.blogspot.com/2013/02/become-member-of-naha.html

Please submit your completed application with payment to: NAHA PO BOX 27871 Raleigh, NC 27611-7871 OR Email completed application to: info@naha.org OR: Fax: (919) 594-1065 Office: (919) 917-7491

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