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 International Thai Therapists Association

 Membership Application


 
Please complete the following:
 
* Indicates a required field.

APPLICATION INFORMATION:

Login (Screen Name) (no spaces)*
Email
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Title* (Mr./Mrs./Miss/Ms./Dr.)
First Name*
Middle Name
Last Name*
Suffix (M.D., CTP, Sr., Jr., etc.)
   
Institution/School Name
  If applying as Institution/School/Instructor
Position with Institution/School
  If applying as Institution/School/Instructor
   
Address*
City*
State*
ZIP Code (Postcode)*
Country*
   
Primary Phone (With Area Code)
Primary Phone Area Code Only
Home Phone (For ITTA Use Only)
Cell Phone
Fax Number
Birth Day
Birth Month
Birth Year
Marital Status
Referred By


 
MEMBERSHIP LEVEL:

The following information will appear on search results and your public profile
and will be viewable to all via the internet
 
Membership Level*
Membership Level (Advanced)

Click here for a
description of the
membership levels
  		Yes! I also wish to apply for ABMP insurance with my membership! : TYC students only  
Primary Style
Gender

 
PUBLIC PROFILE INFORMATION:

The following information will appear on your public profile
and will be viewable to all via the internet.
If your membership is approved, you will be provided
with additional display options for your public profile.
Do Not Display My Profile to the Public   

 
If you wish to be searchable in the directory, please complete as much information as you are comfortable sharing. Your listing will only be searchable if you complete at least some of this information.
 
First Name to Display on Profile
Last Name to Display on Profile
Institution/School Name to Display on Profile
   
Directory Type 1
Directory Type 2
Directory Type 3
Name of School/Instructor Where Trained


 

Please note: ITTA, Inc. A Private Member Association, membership fees are inclusive of application and review fees which are equal to the cost of membership. We do not guarantee membership. Once submitted, there will be no refunds of any kind in the event applications are not approved for any reason. You must agree to abide by the ITTA Code of Ethics and the Association Articles of Education and Healthcare Membership as a precondition towards acceptence. If you have any questions regarding your eligibility, you must call or email the office with questions BEFORE you apply. Thank you.


PLEASE SELECT FROM THE ABOVE LIST
THAT YOU ARE A HUMAN - SPAM PROTECTION

Any misuse of this site for spam or inappropriate content will result in your profile being removed.

 

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Copyright© 2010, International Thai Therapists Association, Inc., All rights reserved. ITTA, Inc. is a Private Membership Association.

  Updated 06/11/2010