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ICANT, “…but with God, all things are possible.” Matt. 19:26
RENEWAL OF MEMBERSHIP APPLICATION FORM
(For new members please contact secretary address, web site etc at bottom of page.
(down load new membership form from website.)
PLEASE POST TO – Address at bottom of page.
YOUR DETAILS ( Please write full name)
Surname………………………….…… Given Names…………….………………………………….
Address…………………………………………………..……………………………………………….
………………………………………………………State..…………… Post Code.............………...
Year for which you are paying …………………………
Telephone: …………………………………….... Mobile……….……………………………………..
Business name ………………………………………..………………………………………………...
Address ……………………………………………State………………Post Code………….............
Email address: …………………………………………………………………
FEES ARE DUE JANUARY EACH YEAR
Student / Associate
Annual fee of $25.00 (no accreditation fee required)
Massage/Remedial Therapist
Annual fee of $50.00 plus Initial non-refundable accreditation fee of $50 (on first application)
Practitioner
(Medical Practitioner; Naturopath, Phyto therapist; Natural therapist; Nutritionist; Hydro
therapist)
Annual fee of $100.00. plus Initial non-refundable accreditation fee of $50 (on first application)
PRACTITIONERS MUST INCLUDE COPIES OF CPD FORM, CURRENT INSURANCE AND
FIRST AID CERTIFICATE BEFORE CERTIFICATES WILL BE ISSUED. PAYMENT
can be made by:- Cash – but not advised in post.
Cheque or Money order – made out to -ICANT Inc.
Bank Deposit: Bendigo Bank. BSB:633 000 Acc No:125 168 633 Reference: your name
Credit Card Payment - __Visa __Master Card Amount $____________
Card Holders Name ______________________________________________
Credit Card Number: __/__/__/__ __/__/__/__ __/__/__/__ __/__/__/__
Expiry Date ____/____ CCV # ___/___/___ (last 3 digits on back of card)
Signature ______________________________________ Date__/__ __/__ 201__
Schedule 1 Association
Registered Office: P O Box 55 Kuttabul Qld 4741 Australia
Ph: 07 49540285
email: icantinc@gmail.com Web site: www.icant.org.au ABN 66 573 324 585 |
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