Member Application Form

Thank you for your interest in becoming a member

To complete this form you will need to include qualification, insurance and first aid certificate information and confirm you agree to the Yoga Therapy Association terms of use, code of ethics and privacy policy

Please note if you are a student member you will only be added to the register of yoga therapists once you have completed your qualification and sent through a copy of your certificate

Personal Information

First and surname

Name of your business (if applicable)

Full address:

Country

Phone number (ie: +44 with no gaps)

Preferred Pronoun

Yoga Therapy Training

What qualification do you have:

The yoga therapy programme from which you graduated or are attending and their details:

(name, address, phone & email)

Date Graduated

(or will graduate if you are trainee yoga therapist)

YYYY

I certify that I have graduated from the above named school and have received my certificate of completion.

First Aid Certification

As a Yoga Therapist/Trainee I certify that I have a certificate of completion for First Aid:

When does your First Aid come up for renewal or do you complete your course?

This will be required to be listed on our register of professionals on our website. If the answer is 'No' please explain why.

YYYY

Insurance Information

I certify that I have insurance to practice Yoga Therapy:

Please give details below of your provider :

(please put NA if you answered 'no' above)

If 'No' please explain why and when you plan on having insurance (if applicable).

This will be required to be listed on our register of professionals on our website. Please put 'NA' if answered 'Yes' above.

Renewal Date of your insurance:

YYYY

Yoga Therapist Register

Information given in this section will be used to create your profile on the register. If you do not wish to share particular details then please leave that field blank.

Please confirm you give permission to be included on the Yoga Therapy Association register of yoga therapists

This will include your name, given email address, contact telephone number and website (where this information is available)

Areas of additional specialty, interest and/or trainings:

(ie: Physiotherapy, Counsellor, Psychologist, Back Care, Stress, Sleep) Please put 'none' if not applicable.

Please provide the location you would like displayed on the register

(ie: city, county, country)

Please provide your website address for the register of yoga therapists (if applicable)

http://

Email for register

Please provide the email address you would like to appear on the register

Phone number for register

(including country code ie: +44 and no gaps)

Additional Information

How did you hear about the Yoga Therapy Association:

(please tick all that apply)

I give the Yoga Therapy Association permission to contact me via:

SMS

Phone

Post

Declaration

This will serve as my signature for the content of this form.

By submitting this form a) I am agreeing to the Code of Ethics, Terms of Use, and Privacy Policy of Yoga Therapy Association (available via the website), and b) I am stating that all the contents in this form are true to the best of my knowledge.

Date form completed

YYYY

Place of registration: Companies House - Registered number: 13946062

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