AAPNA Professional Membership Initial Application / Renewal Application & PACE Provider Application
{{ Cognito.resources['order-transaction-details-header'] }}
{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}
{{ Cognito.resources['order-billing-info-header'] }}
{binding BillingName}
{binding BillingAddress.FullInternationalAddress}
{binding PhoneNumber}
{binding EmailAddress}
| {binding Group} | |
| {binding Name} - {binding Description} | {binding displayValue} |
| {{ Cognito.resources['payment-subtotal'] + ":" }} | {binding displayValue} |
| {{ Cognito.resources['order-total-label'] }}: {binding displayValue} | |
| {{ Cognito.resources['order-amount-paid'] }}: | ({binding displayValue}) |
| {{ Cognito.resources['order-balance-due-label'] }}: | {binding displayValue} |
Please fill out the membership application below. Please be sure to fill in all the * required fields. Once you fill and submit the form, continue to your payment.
Special Note: All the initial and renewal members should submit the application. Renewal members may have changed their address, emails, phone or businesses, and aquired additional training and certifications.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Business Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Certificate Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Day Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Referred by {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Please attach a photo of yourself. (.jpeg, .gif or .png) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Please attach a copy of your degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate (.jpeg, .gif or .png) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
1. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
2. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
2. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
SELECT THE APPROPRIATE MEMBERSHIP
Members who register for 10 years are AAPNA Ambassadors and will receive an additional certificate indicating so.
Student member {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.L.C. - Registered Ayurvedic Lifestyle Consultant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.H.C. - Registered Ayurvedic Health Counselor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.P. - Registered Ayurvedic Practitioner {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.D. - Vaidya / Registered Ayurvedic Doctor: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.D.A.M. - Registered Doctor of Ayurvedic Medicine: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.I.A.D. - Registered Integrative Ayurvedic Doctor: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.I.A.R. - Registered Integrative Ayurvedic Researcher: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
SELECT THE APPROPRIATE SPECIALIZATIONS
Prerequisite for all speciality certifications - Ayurvedic Lifestyle Consultant
R. A.F.N.C. - Registered Ayurvedic Food and Nutrition Consultant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.P.K.T. - Registered PanchaKarma Technician / Therapist: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.M.T. - Registered Ayurvedic Marma Therapist {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.Y.T. - Registered Ayurvedic Yoga Therapist {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.H. - Registered Ayurvedic Herbalist (Dravyaguna) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.D.T. - Registered Ayurvedic Doula Therapist {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.P.T. - Registered Ayurvedic Polarity Therapist {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.Ph. - Registered Ayurvedic Pharmacist (Rasashastra & Bhaishajya Kalpana) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.A.T. - Registered Ayurvedic Aroma Therapist {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.P.C. - Registered Ayurvedic Psychology Consultant (Manasa Shastra) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.A.B.S.T. - Registered Ayurvedic Beauty & Spa Therapist (Soundarya Shastra) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.V.V.C. - Registred Vedic Vastu Consultant (Sthapathi) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.V.A.C. - Registered Vedic Astrology Consultant (Jyothishi) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
R.M.S.I. - Registered Meditation and Spirituality Instructor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
P.A.C.E. Provider - Professional Ayurvedic Continuing Education {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }