ANFTP Application

Membership Application for the Association of Noetic Field Therapy Practitioners (ANFTP)

Please fill out this application completely, sign and mail it with the $20 application fee and $65 membership fee to the ANFTP. The acceptance and records process will take 4 - 6 weeks after which your welcome letter and website keyword will be mailed to you.

Return this Application to:

Dani Burke - Director

7438 Clubhouse Road

Boulder, CO 80301

Phone: 303.530.3141

Fax: 303.473.0670

E-mail: anftdirector@burkedes.com

Please type or print all the asked for information. Illegible applications will be returned.

1. NAME: First _____________________Middle Init____ Last___________________________

2. MAILING ADDRESS:

Street or PO________________________________________________________________

City_______________________________________ State_____________ Zip____________

3. CONTACT NUMBERS: including area code first

Office____________________ Home_____________________ Cell____________________

Fax______________________ Email address______________________________________

4. DATE OF BIRTH: (Month/Day/Year)_______________________

5. Please describe your MAJOR FIELD(S) OF WORK OR STUDY (if any):

Major Field Name___________________________________________________________________

__________________________________________________________________________________

6. HIGHEST DEGREE HELD (if any):

Degree Name (PhD, EdD, PsyD, MA, MSW, BA, etc.) ______________________________________

7. CURRENT PRINCIPAL EMPLOYMENT:

Position or Title_____________________________________________________________________

Employer, Institution or Firm___________________________________________________________

Employed From (Month/Year)______________ Employed To (Month/Year)________________

8. PROFESSIONAL LICENSURE:
Are you licensed or permitted by any state, federal, provincial, or etc. board? Yes_____ No___

What is the licensure? ________________________________________________________________

__________________________________________________________________________________

Have you at any time been convicted of a felony, sanctioned by any professional ethics body, licensing board, or other regulatory body or by any professional or scientific organization?

Yes_____No_____ If yes, please provide description/explanation:____________________________

__________________________________________________________________________________

9. ETHICS:

Have you read the ANFTP code of ethics and you agree to abide by them? Yes_____ No_____

Do you currently use any illegal or non prescribed drugs? Yes_____ No_____

Do you currently have a dependence on tobacco or alcohol? Yes_____ No_____

If you answered yes to either of the above two questions please explain:___________________

__________________________________________________________________________________

10. Is this your first application for professional membership in ANFTP? Yes_____ No_____

11. Have you completed an Aura Balancing Workshop or Training sometime in the past?

Yes_____No_____ If yes, who was the teacher(s)______________________________________

date(s)_________________________________

12. Have you completed the 120hr Noetic Field Therapy Practitioners Program? Yes____ No____

What date did you complete your NFT training?________________ Who was the teacher(s) at that

training?________________________________________________________________________

Please include a copy of your certification of completion.

13. I currently practice _______hours (if any) of NFT a month (on average).

14. Self Study (see the following page)

15. Please discuss your interests and plans with NFT:________________________________________

__________________________________________________________________________________

Applicant's Signature_____________________________________ Date__________________

All done? Check the following: Have you completed your application? Incomplete applications will be returned. Have you enclosed a copy of your NFT certificate?, Have you enclosed the non-refundable $20 application fee and the $65 membership fee?

NFT SELF STUDY

Please answer the following statements as briefly or in detail as you choose. Please print or type. You may include additional typed or printed pages if necessary.

What is your intention in joining this Association? ____________________________________________

__________________________________________________________________________________

Please describe the ways you have practiced NFT or any ways it may have influenced your life in the last year.

__________________________________________________________________________________

Please describe ways you plan to practice NFT or use it to your advancement in the next year.

__________________________________________________________________________________

Please describe any current spiritual practices or meditations you do.

__________________________________________________________________________________

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