Upgrade Membership Form

Thank you for wishing to be a Professional Member of the Australian Breathwork Association
Fees
Professional Member - $180 annually + $25 joining fee
Renewing membership - $180 annually [[no joining fee, but a $25 late fee will be incurred if paid later than 30 July]

Upgrade Membership Form

* Indicates required field

I wish to *

upgrade my Professional Membership Category

I am currently *

Name *

First

Last

Membership number if known *

Email *

Your website address *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Assurance of Professionalism *

I fulfill the ABA standard for which I am applying I abide by the ABA Code of Ethics I have upload file to support my upgrade

Upload File to support my upgrade *

Max file size: 20MB

I declare that I have current *

Professional Indemnity Insurance Current First Aid Certificate

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

Submit

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.

Upgrade Membership Form

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