Renewal Professional Membership

Thank you for wishing to be a Professional Member of the Australian Breathwork Association
Fees
Professional Member - $180 annually
[$25 late fee will be incurred if paid later than 30 June]

renewal professional Membership Form

* Indicates required field

I wish to renew my professional membership as *

Breathwork Practitioner Breathwork Group Facilitator Breathwork Trainer

Name *

First

Last

Membership number if known *

Email *

Your primary website address *

Phone Number *

Your professional Facebook page *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please upload a square photo approx 480x480px *

Max file size: 20MB

I declare that I have current *

Professional Indemnity Insurance Current First Aid Certificate

I declare that I abide by *

ABA Code of Ethics

Upload Files: Prof. Indemnity *

Max file size: 20MB

Upload File: Current First Aid *

Max file size: 20MB

I declare that I have fulfilled and recorded ABA professional requirements in: *

Continuing Professional Education CPE Peer Support and/or Supervision

Payment can be made by bank transfer to
Australian Breathwork Association
BSB 112-879 Account Number 464587874
Email copy of your receipt to treasurer@australianbreathworkassociation.org.au

Or upload Copy of Receipt *

Max file size: 20MB

I agree to receiving marketing and promotional materials

Submit

Payment with PAYPAL
when you SUBMIT the form you will be taken to a link to pay with Paypal

By filling in this form and submitting it to ABA you acknowledge that you have truthfully answered the questions.
This document then has the force of an affidavit.

renewal professional Membership Form

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