Name:____________________________________________________________
 
Address:__________________________________________________________
Telephone: Home:_______________Work:______________Email:_______________
 
For renewal fill in changes.
 
T.T. Courses and Workshops attended in the past year:
 
Level              Instructor                                        Year                Where
_________________________________________________________________
 
_________________________________________________________________
 
_________________________________________________________________
 
_________________________________________________________________
 
Number of years as a T.T. practitioner:________________
 
Do you wish to be listed on the Network as a T.T. practitioner who is willing to give treatments to clients and allow us to give out your phone number to people looking for T.T. in your area:   Yes:_____  No:_____
 
Other Professional qualifications, talents or abilities you wish to have listed and number of years you have been involved with each:
_________________________________________________________________
 
_________________________________________________________________
 
_________________________________________________________________
 
_________________________________________________________________
 
**Each year we include a list of current MTTN members along with their nearest city or town location and their phone numbers in the summer newsletter. If you do not wish to have your name and or number listed in the mailout please indicate clearly.  I do not want my name listed on the mailed out list__________.
 
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Would you like your name listed on the MTTN Website Yes ___ No ___
If yes, please fill in accurately the information as you wish to have it included:
 
Name_____________________________
Telephone________________________ Email ________________________
TT Level Completed __________________________
Other Qualifications or Modalities you practice ________________________
Relevant Business Information _______________________________________
 
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What are your suggestions for MTTN workshops or activities? 
 
__________________________________________________________
 
What might you be willing to facilitate?
 
__________________________________________________________
 
 
Practice Groups for T.T.
 
______  I participate in a practice group in ( city/ town)______________________
______  The group is facilitated by _____________________________________
______  I would like to participate in a support group.
______  I would like to start a practice group.
 
From our bylaws:
Rights and privileges of members
Members may:
"        Attend and participate in all regular and called meetings of the network.
"        Hold office according to the process of the nominating committee and/or participate in MTTN committees.
"        Participate using consensus and/or voting process on all the issues presented to the membership by the Executive council at the annual general meeting and other meeting that might be called from time to time.
Conduct of Members
"        A member in good standing is one who, in the judgment of the Executive council, conducts himself/herself in a professionally ethical manner, and actively support the Network by interest, presence, and/or participation.
"        Complaints and/or concerns regarding practice or conduct of a member that are received in writing by the Executive council shall be dealt with by the council.
 
 
I would prefer my newsletter via email ______
I would prefer my newsletter in the mail _____
 
Membership Fee is $20.00 per year.  Membership year is from May 1st to April 30th.
Please make cheques payable to Manitoba Therapeutic Touch Network.
 
Send fee and completed form to:
 
Manitoba Therapeutic Touch Network
c/o Lorraine Gauthier(Registrar)
Box 6
Ste. Agathe, Manitoba R0G  1Y0
(204) 882-2373
 
Signature:____________________________________  Date:______________________
 
****At the time of our membership renewal we are given an opportunity to subscribe to the Ontario Newwork's In Touch Newsletter for an additional fee of $15.00.  If you would like to receive this magazine please add this amount to your registration fee.  No newsletter subscriptions will be accepted after May 15th 2007.  Be sure to include your correct mailing address on the front of this form.