GPACT Membership Application

The Global Professional Association for Colon Therapy Membership Application
Select a membership level and our staff will contact you within 48 hours of your form submission. In our effort to be more environmentally conscious, confirmation of your membership, including an e-certificate, will only be sent by e-mail.

Note: Annual membership term runs from the date of your application acceptance to the following year.

* Foundation Level requires completion of GPACT reconized/certified school before membership can be granted

* Levels Intermediate & Advance requires passing exam at 85% or higher before memership can be granted

* Instructor Level requires an interview process before membership can be granted.
Member Information
Name

First NameLast Name
Phone Number
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of your business or company you work with
Business information for Therapist Locator*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business phone number
What are your business hours?
Share your social media handles... website, Youtube, Instagram, etc
How long have you been a Colon Therapist?
Where and when did you receive your training?
How can GPACT support you?
What is your reason for joining GPACT?
Any additional questions, comments or concerns?
Signature

Clear

Certification Level

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