Association of Noetic Field Therapy Practitioners Membership

Membership Application for the Association of Noetic Field Therapy Practitioners
( ANFTP)

Please fill out this application completely, sign and mail it with the $20 application fee and $65 membership fee to the ANFTP. The acceptance and records process will take 4 - 6 weeks after which your welcome letter and website keyword will be mailed to you.

Return this Application to:

Dani Burke, MSS
Attn: ANFTP Membership Department
7438 Clubhouse Road
Boulder, CO 80301
Phone: 303.530.3141
Fax: 303.473.0670
E-mail: anftdirector@burkedes.com

Please type or print all the asked for information. Illegible applications will be returned.

1. NAME: First _____________________Middle Init____ Last_________________________

2. MAILING ADDRESS:

Street or PO______________________________________________________________

City_______________________________________State____________Zip___________

3. CONTACT NUMBERS: including area code first

Office___________________Home____________________ Cell___________________

Fax______________________Email address____________________________________

4. DATE OF BIRTH: (Month/Day/Year)_______________________

5. Please describe your MAJOR FIELD(s) OF WORK OR STUDY(s) (if any):

Major Field Name__________________________________________________________

________________________________________________________________________

6. HIGHEST DEGREE HELD (if any):

Degree Name (PhD, EdD, PsyD, MA, MSW, BA, etc.) _________________________________

7. CURRENT PRINCIPAL EMPLOYMENT:

Position or Title____________________________________ ________________________

Employer, Institution or Firm___________________________________________________

Employed From (Month/Year)______________Employed To (Month/Year)________________

8. PROFESSIONAL LICENSURE:
Are you licensed or permitted by any state, federal, provincial, or etc. board? Yes_____No___

What is the licensure? ________________________________________________________

________________________________________________________________________

Have you at any time been convicted of a felony, sanctioned by any professional ethics body, licensing board, or other regulatory body or by any professional or scientific organization? /p>

Yes_____No_____ If yes, please provide description/explanation:________________________

_________________________________________________________________________

9. ETHICS:

Have you read the ANFTP code of ethics and you agree to abide by them? Yes_____No_____

Do you currently use any illegal or non prescribed drugs? Yes_____No_____

Do you currently have a dependence on tobacco or alcohol? Yes_____No_____

If you answered yes to either of the above two questions please explain:___________________

_________________________________________________________________________

10. Is this your first application for professional membership in ANFTP? Yes_____No_____

11. Have you completed an Aura Balancing Workshop or Training sometime in the past?

Yes_____No_____ If yes, who was the teacher(s)____________________________________

date(s)_________________________________

12. Have you completed the 120hr Noetic Field Therapy Practitioners Program? Yes____No____

What date did you complete your NFT training?________________ Who was the teacher(s) at that training?_______________________________________________________________

Please include a copy of your certification of completion.

13. I currently practice _______hours (if any) of NFT a month (on average).

14. Self Study (see the following page)

1515. Please discuss your interests and plans with NFT:_________________________________

_________________________________________________________________________

Applicant's Signature___________________________________Date__________________

All done? Check the following: Have you completed your application? Incomplete applications will be returned. Have you enclosed a copy of your NFT certificate? Have you enclosed the non-refundable $20 application fee and the $65 membership fee?

NFT SELF STUDY

_________________________________________________________________________

Please describe the ways you have practiced NFT or any ways it may have influenced your life in the last year.

_________________________________________________________________________

Please describe ways you plan to practice NFT or use it to your advancement in the next year.

_________________________________________________________________________

Please describe any current spiritual practices or meditations you do.

_________________________________________________________________________