AAPNA Professional Membership Application / Renewal

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{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{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.

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

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 }

{binding Name, mode=oneTime}

{binding Description}

Please attach a copy of your degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Please attach a copy of any additional degree / diploma / certificate (.jpeg, .gif or .png) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Please attach a copy of any additional degree / diploma / certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Please attach a letter of reference from an individual familiar with your practice in your country (.pdf) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

SELECT THE APPROPRIATE MEMBERSHIP

Members who register for 10 years are AAPNA Ambassadors and will receive an additional certificate indicating so.

Student / General Member (Supporter) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Lifestyle Consultant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Practitioner {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Vaidya / Ayurvedic Doctor (B.A.M.S. & Higher) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SELECT THE APPROPRIATE SPECIALIZATIONS

Minimum Prerequisite - Ayurvedic Lifestyle Consultant

Ayurvedic Food & Nutrition Consultant (A.F.N.C.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Panchakarma Technician (A.P.T.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Marma Therapist (A.M.T.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Yoga Therapist (A.Y.T.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Herbalist & Pharmacist (A.H.P.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Psychology Consultant (A.P.C.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Ayurvedic Beauty & Spa Consultant (A.B.S.C.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Vedic Vastu Consultant (V.V.C.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Vedic Astrology Consultant (V.A.C.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Meditation & Spirituality Instructor (M.S.I.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Professional Ayurvedic Continuing Education (P.A.C.E.) Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Agreement of Understanding Regarding P.A.C.E. (Professional Ayurvedic Continuing Education) Providers' Code of Conduct and Membership {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Agreement of Understanding Regarding Code of Conduct and Membership {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

May AAPNA share your contact information with other ayurvedic resource groups? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Agreement of Understanding Regarding Membership {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

AAPNA Professional Membership Application / Renewal

{~ Payment_Block_Label}

AAPNA Professional Membership Application / Renewal

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

AAPNA Professional Membership Application / Renewal

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}