New Membership Application

Join as a member, and sign up for one our our distance learning courses for free.
This is a $185 additional value.
Upon joining and receiving your invoice you will receive a link to the registration page for your free course.



Name & Address
Title
First Name *
Last Name *
Suffix
Academic Degree(s) -- Masters & above.
Designation(s) (Abbreviate recognized certifications.)
Memberships (Name or abbreviate organizations which you currently hold memberships.)
Name of company, institution, or practice
Address *
City *
State *
ZIP or Postal Code *
Country

Contact Information
Office Phone *
Fax Number
E-Mail Address *
Web Address

Qualifications
Please check each category for which you have received a training certificate, degree or license.
Please do not check any category for which you have not received adequate training or licensure for your legal jurisdiction.

Acupuncture
Ayurvedic Medicine
Biofeedback
Chiropractic
Coaching
Cognitive Based       Therapy (CBT)
Counselor
Dance/Movement       Therapy
Dentists
Energy Medicine
Energy Psychology
Homeopathy
Hypnotherapy
Massage Therapy
Medical Doctor       (Allopathic)
Medical Technology
Medical       Administration
Music Therapy
Naturopathy
Neurofeedback
Neurolinguistic       Programming (NLP)
Nursing
Oriental Medicine
Osteopathic Physicians
Psychology
Psychotherapy
Qi Gong
Quantum       Focus
Quantum       Touch
Reiki
Social worker
Therapeutic       Touch
Yoga Teacher
Other

Membership Level

Please select your appropriate level of membership.
Your credit card will be charged based upon your selection.
Fees shown are payable annually.

Practitioner
      (Clinician,
      Researcher,       Instructor)
       $89 per year
Student
      (Currently enrolled
      in affiliated school or
      university and not a
      practitioner)
      $55 per year

School Code:
Retired
      (60 years old
      or older and not
      a practitioner)
      $55 per year
Corporate
      (Educational
      institution, research
      facility, or clinical
      practice. May add up
      to four more
      practitioners
      upon joining.)
      $249 per year

Additional Information
Please let us know if any of these three categories apply.
Author
      (Published books, journal
      papers, printed or on-line
      articles)
Speaker
      (Professional speaker or
      presented at a conference)
Trainer
      (Corporate trainer, conducts
      workshops, or conducts
      certification training)

Referral Directory Comments
For Practitioners and Corporate Members only. Please check the "Include in Referral Directory" box and include text if you wish to be added to our Referral Directory. This directory will available for the general public.

Include in Referral Directory

Your directory comments:


You have 250 remaining characters.


Credit Card
Please enter credit card information.
If you do not wish to use a credit card, please print this completed form, include your check, and mail to:
IHRI, PO Box 367, Anniston, AL 36202

Charge amount due to my credit card (AMEX / Discover / Master Card / VISA)

Card Number:  Required
Expiration Date:  Required
3 or 4 Digit Security Code
(from back side of card):
 Required
Name as shown on card:  Required
Billing Address:  Street Only!  Required
Billing State or Province:   Required (If not applicable, write None.)
Billing ZIP (Postal) Code:  Required

I certify that I have reviewed the contents of this entire form and that my entries are correct. I understand that membership is at the sole discretion of the Institute. I attest that I will comply with the Institutes's Ethical Guidelines and agree to have my credit card charged the selected amount. All sales are final.

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