CHI MEMBERSHIP APPLICATION FORM
After filling the details, please click on the SUBMIT button.

  First Name:
  Last Name:
  Street address:
  City:
  State, Zip Code:
  Country:
  Phone No:
  Email:
  Website:
  Education:  High School
 College Graduate
 Other
  If other (please specify):
  Please fill in 1-4 if you are a hypnotherapist:
  1. Hypnotherapy School:
  2. Dates attended:
  3. Areas of Hypnotherapy practice:
  4. Time devoted to Hypnotherapy practice per week:
  Please specify other healing practices:
  Language spoken:
  Names of professional organization affiliations:

After filling the details click on the SUBMIT button.
 
 
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