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.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Business Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Certificate Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Day Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Referred by {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please attach a photo of yourself. (.jpeg, .gif or .png) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please attach a copy of your degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate (.jpeg, .gif or .png) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
1. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
2. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
2. Reference Person: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
SELECT THE APPROPRIATE MEMBERSHIP
Members who register for 10 years are AAPNA Ambassadors and will receive an additional certificate indicating so.
SELECT THE APPROPRIATE SPECIALIZATIONS
Prerequisite for all speciality certifications - Ayurvedic Health Counselor or Lifestyle Consultant
PACE - Professional Ayurvedic Contiuning Education Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }