Membership Application/Information and Dues Statement

Please complete information requested and pay dues as specified below.

Name: First Middle: Last:

Highest professional degree earned: B.A.      Ed.D.      M.D./Ph.D.      Ph.D.      B.S.      M.A.      M.S.      R.N. D.D.S.      M.D.      M.S.W.      R.P.T.      None      Other (Please specify)

Title:

Business Name if any

Address Suite:

City, State, Zip

Telephone Work Phone

E-mail Address Website

Disciplines/Interests: Experimental Clinical Theoretical/Philosophical

Major Minor

Professional activity (check your related profession(s): Chiropractor, Counselor, Clergy, Dentist, Dietitian, Exercise Physiologist, Health Educator, Marriage & Family Counselor, Nurse, Nutritionist, Osteopath, Physical Therapist, Physician, Psychologist, Psychotherapist, Social Worker, Stress Management Consultant, Student, Other (please specify)

Please check those areas in which you hold a professional license:
D.D.S. M.D. Ph.D. R.P.T. None
D.C. M.S.W. R.N. Other (please specify)

The following disciplines, approaches, interventions, treatments, and techniques are relevant to the exploration of subtle energies and energy medicine. Please indicate all areas in which you are involved (circle responses):

1. Biology

2. Anthropology       

3. Chemistry       

4. Parapsychology       

5. Physics       

6. Psychology       

7. Philosophy      

8. Instrumentation       

9. Bioelectromagnetics       

10. Mind/Consciousness       

11. Medicine(specialty)

12. Osteopathy       

13. Behavioral medicine (biofeedback, psychoneuroimmunology)      

14. Comparative Religious Studies

15. Traditional Chinese Medicine (specify)       

16. Oriental Medicine (specify)

17. Homeopathic Medicine       

18. Native American Medicine       

19. Chiropractic       

20. Body Therapies/Energy Work (Reiki, Acupressure, massage, etc.)      

21.Body/Mind Therapies (Primarily Mind) - attitudinal healing, autogenic training, hypnotherapy, music (vibrational), color and light

22.Other (please specify)

Estimate the amount of your professional time which you devote to the areas of Subtle Energies & Energy Medicine. (please check your choice)             1 - 10%      11 - 25%      26 - 50%      51 - 75%      76 - 100%

Of the percent of time indicated, divide 100 points among the following areas of activity incorporating the use of subtle energies and energy medicine: Research    Clinical    Teaching/Educational applications    Other (please specify)

How did you find out about the Society?

Professional or Associate Members $ 75.00

Professional or Associate International Members $84.00

Seniors, Students& Income Limited Members* $ 45.00   
*Please provide copy of student I.D. or brief letter requesting seniors or limited income rate to comply with po licies.

Seniors, Students& Income Limited International Members* $ 54.00   
*Please provide copy of student I.D. or brief letter requesting seniors or limited income rate to comply with po licies.

Institutional Members $200.00       (3 copies of each issue of Magazine and 2 of each issue of the Journal)

Institutional International Members $229.00       (3 copies of each issue of Magazine and 2 of each issue of the Journal)