Energy Healers Association ASSOCIATE MEMBERSHIP APPLICATION FORM

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ASSOCIATE MEMBERSHIP APPLICATION FORM Membership includes regular email updates, occasional educational meetings, and virtually unlimited promotion of practitioners', trainer's or schools' services on http://www.energy-healers-association.org/category/news/, subject to the promotion being newsworthy and/or written in an informative and educational way, such as case studies explaining how you or your client were before the treatment and after the treatment, and how this treatment affected the person's life in a positive way. Promotions can be in the form of articles or videos already hosted on an easy-to-use medium such as Youtube. Additionally, we have occasional external promotions, such as a recent one where we placed 30 TV advertisements, and promotions in shopping malls, to mention just two. Name Address Telephone Email address Website (If any) 1

Healing modalities (Please list your healing modalities, and include a photocopy of your certificates) Aims The is here to represent the energy practitioners and to promote the use of energy healing modalities to help people to help themselves and help others to improve their lives and be healthier and happier. The is currently undergoing the process of having our modalities approved by the South African government, so that your certification will mean an officially approved qualification at the highest level, and so that we will eventually be able to claim from medical aid schemes for our healing. YOU MUST SIGN THESE CODES & ETHICS - CODES OF CONDUCT Confidentiality: * The practitioner must adhere to client confidentiality (keeping a client's secrets), unless a child is being seriously abused (such as sexually) or someone's life is in danger (for example, if the client said they intend to kill their spouse that night). * Personal details such as phone numbers, email addresses and addresses of clients are privileged information may not be sold or given out to marketing companies. * Any details of the treatment are also confidential, and written permission from the client is required before using the information in an article or case study. * Client details need to be stored securely under lock and key. If these details are on a computer, they need to be accessed with an alphanumeric password, which must also be securely placed. 2

* Client details need to be stored for a minimum of 7 years, in case they are needed for legal reasons. * The client's doctor may only be contacted with the client's written permission. Competence: * The practitioner must not practice in return for payment, or in a formal voluntary role (for example, working as a volunteer practitioner in a mental health or cancer charity), or in a free marketing or customer service role (for example, during a free talk) any modality in which they have not received formal training to practitioner level. If the practitioner wishes to practice without any financial or commercial reward a modality in which they have not received practitioner-level training, they must make it totally clear to their client that they do not have the appropriate training, be sure that they have permission from the client to do so, and must limit this practice to very close family and friends only. An exception to this is where the practitioner is doing a treatment under strict supervision, and according to the instruction of their trainer, whilst doing their professional-level training (for example, performing a Reiki case study as instructed by their Reiki Master). * The reserves the right to approve or disapprove of professional-level training. This approval is subject to successful application from the practitioner and/or the training body. Sessions: * Sessions should take place in a safe and comfortable place. * A client needs to be treated with the utmost respect and non-judgement: even if what they are saying goes contrary to the practitioner's way of thinking. The issues need to be worked through without prejudice. * A Practitioner is in a position of trust and must never cross inappropriate boundaries. This includes the touching of private parts and requests to disrobe (unless it is part of, for example, an additional massage treatment the practitioner is additionally qualified to practice and the client has already requested and agreed to). * Children may be seen with the parent's written permission. If the parents leave the child alone with the practitioner, it is recommended that the practitioner get an indemnity signed to cover for personal injury in cases where the child is a self-harming patient. * Practitioners must never promise a cure for any problem. * The doctor's care takes precedence over the complementary practitioners エ care and it must never be recommended that they leave this care. With energy healing, you are addressing the underlying energetic patterns with the goal of bringing balance and harmony within the energetic field of the person, when the body's energy field is balanced and flowing without disruption, the body can naturally heal itself. This does not replace medical care. * There are instances where energy healing is not the most appropriate immediate or other action, particularly where the client is needing urgent 3

hospitalization (medical emergency, such as heart attack), a danger to themselves (about to commit suicide), others (some extreme psychiatric cases). Here the nearest emergency room may be contacted or a crisis line may be phoned. * Unless the practitioner is also a qualified nutritionist, dietician, or other suitably qualified medical practitioner, they may not prescribe supplements or advise on nutrition. They may, however, recommend one of these professionals in appropriate circumstances e.g. anorexia. Pre-treatment agreement between the practitioner and client: It is important to fully inform the client. They need to know about the possibility of the risk of an abreaction and allow them to have the opportunity to exit at this point and not have the treatment if that is their wish. Upholding the : There also needs to be the following agreement regarding the Energy Healers Association: * To always represent the energy healing techniques approved by the Energy Healers Association and taught or trained by providers approved of by the. * Not to take action that will be harmful or slanderous to the Energy Healers Association, any of its members or any of its approved healing methods. You should never bring the association into disrepute. * Should there be wrong-doing by a member of the Association, the procedure is that members of the public and members of the Association report it to the committee, who will then decide upon appropriate action, after due process of a disciplinary committee hearing which could also include a monetary penalty and/or expulsion from the association. Online, phone, and distant work: * As part of the pre-treatment agreement, the practitioner will make the client aware of legal disclaimers. This is particularly pertinent when the session is conducted online via Skype or telephone. * The practitioner and client must understand: -the risks, benefits and alternatives to online, phone, and distant work, for example, differing laws across country or state borders. -that every effort will be made to keep information confidential. However no internet or phone communication can be completely free from those that hack, but the practitioner undertakes to keep information secure on his/her side. The client needs to do the same. -that the practitioner qualifications have been openly shared and that there is agreement to work together under this knowledge. Disciplinary Procedures as per http://www.energyhealerassociation.org/wp- content/uploads/2010/10/disciplinary-procedure-energy-healers- 4

ASSOCIATION-.pdf : * Practitioners will follow and abide by any disciplinary decisions made by the committee of the, which may include expulsion. * The main concerns in the rare occurrence of disciplinary action are to protect the public and uphold the reputation of the association and all its members who abide by its Codes and Ethics. I agree to the codes and ethics above. Signature Name: Date: Membership Membership includes regular email updates, occasional educational meetings, and virtually unlimited promotion of practitioners', trainer's or schools' services on http://www.energy-healers-association.org/category/news/, subject to the promotion being newsworthy and/or written in an informative and educational way, such as case studies explaining how you or your client were before the treatment and after the treatment, and how this treatment affected the person's life in a positive way. Promotions can be in the form of articles or videos already hosted on an easy-to-use medium such as Youtube. Additionally, we have occasional external promotions, such as one where we placed 30 TV advertisements. Individual Associate membership - R100 For 1 year. This is For everyone with whose association the is yet to complete negotiations. So we cannot approve of anyone officially as a Practitioner in their field until we complete the lengthy negotiations involved. CPD Trainer - 500 Per year OR R50 monthly. This is for trainers in fields where we have not as yet completed the lengthy negotiations required by the South African Qualifications Authority in order to agree on standards. This does NOT mean that we look into your training manual at ANY stage. If paying monthly, please set up a standing order to ensure regular payments. Benefits include your website listing with your website or email links, plus virtually unlimited marketing on our News section as above, as well as other ways of marketing/advertising, at no extra charge. CPD Trainers who wish to be approved by the must fill in the Practitioner 5

Application Form and additionally supply information on their training classes (please see overleaf). Make Your Payment - Banking Details You must reference your payment with your name or the name of your healing/training organisation or simply your name if a sole trader. FNB BUSINESS ESSENTIAL ACCOUNT : 62339114902 Branch code 203809 For outside South Africa, SWIFT Bank Code :FIRNZAJJ Now scan and email this completed form plus proof of payment and Copy of your healing Certificates, Matric or Higher certificate (if you have this) and a copy of your ID (it does not have to be a certified copy) to suzanne@energy-healers-association.org If you do not have access to scanning facilities, please mail the above to our address as per the footer below. 6