Australian Hypnotherapists’ Association

Founded 1949 - ABN 20 004 388 872
" and its member associations ASTA and ASHOCHA "
P: 1300 55 22 54
E: admin@ahahypnotherapy.org.au W: www.ahahypnotherapy.org.au

Application for Clinical Membership

IMPORTANT! All application’s are to be submitted via this digital form, forms received in printed form will be rejected.

Max length is 30. Required.
Max length is 30. Required.
Required. Valid e-mail address. Max length is 70.
Max length is 70.
Max length is 128.
Max length is 100.
Max length is 30.
Max length is 60.
Max length is 60.
Max length is 60.

Your postal address

Max length is 80.
Max length is 50.
Max length is 10.
Max length is 15. Required.
Max length is 50.

Have you ever been refused acceptance or had any disciplinary action taken against you by any other association?
Yes No    If ‘Yes’ please give details below.
Have you ever been convicted of a criminal offence (not including minor traffic offences)?
Yes No    If ‘Yes’ please give details below.

Note: All attachments below could be of [.doc(x), .pdf, .jpg, .png, .txt, .rtf]. Max size per attachment 5MB.


First Aid Certificate:

Max length is 90.

Professional Indemnity Insurer:

Max length is 90.

Police check:

Max length is 90.

Working with children check:

Max length is 90.

Details of your current Supervisor or a member of your peer supervision group:

Other Supervisor (not listed above):

Max length is 70.
Max length is 90.
Max length is 10.
Max length is 60.
Valid e-mail address. Max length is 70.

References & Driver License:


I advise that I am currently engaged in a program of study and I enclose evidence of study herewith.
Markdown wiki syntax Max length is 5000.
Markdown wiki syntax Max length is 5000.
Yes No
Markdown wiki syntax Max length is 5000.
Markdown wiki syntax Max length is 5000.

The following information is used for referral purposes only

I offer aged pensioner discounts
Yes No
I give permission for my name to be included in the monthly listing sent to the Health Funds
Yes No

I am interested in contributing to the AHA with the following:

Please contact me as to what I could contribute
Yes No

Current workplace address

Please be aware that this is the address sent to the health funds and is crucial to rebates being paid. (this reads to the practice address’s I would think a multiple entry system would be best such as once they have filled in the info they can add as many times as they like, or it goes to a link for them to check their information that is already entered)

Practice address 1

Max length is 100.
Max length is 50.
Max length is 50.
Max length is 50.
Max length is 50.
+ Add Practice address

Payment and agreements

Direct Deposit details

 

Account Name: Australian Hypnotherapists’ Association

Bank Address: Paddington

Branch No (BSB): 062 220

Account No: 10012818

I enclose the prescribed one off non-refundable application fee of $44.00 inc GST. Direct Deposit details

Please load proof of payment. Cheque also accepted please post to National Office, 42 Waratah Street, Bexley, NSW 2207

OR

Click on the link below to pay the application fee of $44.00 online with Card (opens a new browser tab). After the payment is performed please return back to complete the application form submission.

Pay Now online $44.00 with Card


I have read and agree to abide by the AHA’s Code of Ethics. I agree to hold the AHA indemnified for all judgments and costs awarded against it or incurred by it, as the case may be, in any action against it, arising directly or indirectly from my conduct as a Hypnotherapist.
I understand that the yearly Clinical Membership Registration fee is $240 inc GST and is due on the 31st of March each year
I understand and agree that the Executive of the Association may from time to time during the tenure of my membership review and amend its policies and procedures and that all relevant amendments will apply to me from the date specified by the Executive.
I understand and agree that a condition of my continued eligibility for membership in the Association is that I will maintain in force at all times with an approved Insurer a Public Liability Policy and a Professional Indemnity Policy each one providing Indemnity for my practice as a Hypnotherapist for an Indemnity amount of not less than $2,000,000 Professional Indemnity Insurance Cover and $10,000,000 under each of the two classes of insurance and that I will lodge a copy of each Certificate of Currency with the Association.

I also understand and agree that a condition of my continued eligibility for membership in the Association is that I will maintain a current First Aid Certificate. NB: An invalid Certificate may void Professional Indemnity Insurance, AHA Membership and the ability for your clients to receive a Health Fund Rebate.

I agree that a further condition of my continued eligibility for membership of the AHA is that I undertake a minimum of 20 hours each year of studies/training which may be in the form of workshop/seminar attendances or other courses which would be seen as enhancing my hypnotherapeutic skills.

I also agree to undertake a minimum of twelve (12) hours of one-on-one Supervision each year OR a minimum of Twenty-four (24) hours of Peer Group Supervision or a mixture of both Supervision models per year NB: A Group Supervision hour equates to 0.5 of a one-on-one Supervision hour.

I further agree to attend at least 50% of the Association’s State meetings/workshops unless it can be shown that there was a valid reason for not being able to do so.

I also agree to maintain an adequate professional library


AHA Advisory Line 1300 55 22 54