Alliance for Integrative Wellbeing Practitioner Membership Registration

First Name

Last Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Country

State/Region

Preferred Pronouns

Please tell us a little about you

Other

Professional Title (If you have one)

Business or Practice Name (If you have one)

If you are a student or graduate please tell us the name of your training provider/college/school or university.

Modality or Areas of Practice (If you are practicing)

Brief Description of Practice (If you have one)

Confirmation of information accuracy

Scope of practice confirmation

Legal and professional compliance

Professional and ethical conduct

Membership status acknowledgment

Representation of AIW

Consent to Contact

Accurate professional representation

Registration - Please select your membership below.

AIW Practitioner Membership Registration - One Year (includes GST)

Please note: This membership is for individual members and practitioners only. Training providers, colleges and education organisations are not eligible for this membership and should apply for AIW Training Provider Membership.

$187.00 AUD

AIW Practitioner Membership Registration - Monthly (includes GST)

Please note: This membership is for individual members and practitioners only. Training providers, colleges and education organisations are not eligible for this membership and should apply for AIW Training Provider Membership - Your subscription will be drawn from the card you use now on the same date each month.

$22.00 AUD

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Alliance for Integrative Wellbeing Founding Practitioner Membership Registration

Personal Details

Professional Standards

Registration - Please select your membership below.