New Member Registration Form

1
You have selected the Wellness Practioner designation.

If you also have yoga or meditation teaching qualifications, you can add these designations after your initial registration as a Wellness Practitioner.
2
Full Legal Name* This field is required.
First and Middle Name
Last Name
3
Email* This field is required.
4
Create a User Handle* This field is required.A "handle" refers to a chosen nickname or alias (similar to what is used in Social Media accounts). When creating your handle: DO NOT use the @ symbol in your handle, and; Ensure the handle is a MINIMUM of 5 characters and MAXIMUM 20 characters. IMPORTANT: Create a distinctive username, as single first names are often unavailable. For instance, if your name is Susan, you could select something like YoginiSusan.
PLEASE DO NOT USE ONLY YOUR FIRST NAME. MAKE IT UNIQUE.
5
Organization Name (if applicable)Example: Zen Massage Therapy
6
Address* This field is required.
Street Address
Street Address Line 2
City
State
Zip Code
United States
Please Select
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Finland
France
French Polynesia
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The Gambia
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Iraq
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Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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North Korea
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Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Phone Number* This field is required.
Enter a valid Phone Number
8
What is your Practitioner Designation(s)?* This field is required.Choose all that apply.
Massage Therapist
Acupuncturist
Naturopath
Dietician
Psychologist
Psychotherapist
Yoga Therapist
Nurse Practitioner
Reiki Master
Chiropractor
Cranio-Sacral Therapist
Counsellor
Herbalist
TCM Practitioner
Osteopath
Other
9
Name of "Other" Designation* This field is required.
10
Do you belong to a Regulatory body for your profession?* This field is required.
YESNO
11
Which Designation(s) do you hold with your Regulatory body?* This field is required.For Example: RMT, NP
12
Your Profile Picture* This field is required.Upload a profile picture. This will appear in our Public Directory. Every profile must include a clear, recent photo of the member.
Drag and drop files here
Select files to upload
Max. file size: 11.7MB
Formats Accepted: JPEG, JPG, PNG
Cancelof
13
Your Wellness Journey* This field is required.Share your journey with us: When did you start your wellness practice? What inspired you? Tell us a little bit about your biography. This information will be visible on your public profile.
You can alway edit this information in your user profile at a later point.
0/0
14
Code of Ethics* This field is required.
15
Code of Conduct* This field is required.
16
Click Submit to create your account.
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