ISH Membership Application Form (Individuals) – The International Society for Hypnosis

Please choose the membership, you like to apply for:

Title

First name

Last name

Gender

Email

Confirm Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Payment A your

Profession

Degree

Of which Constituent Society are you a Member?:

Referred to by:

Resume or Curriculum Vita with information on your field of education and University.:

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

A list and description of your previous training experiences in hypnosis

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

(e.g. workshops and conferences attended, certifications obtained, etc.).:

A copy of your license, registration or credential to practice.:

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Your preferred Payment method

Your application must first be reviewed; payment is due only after it has been approved.

EURO: to pay via the European Account (EUR)

If you pay via this account please choose EUR as the currency.

International Society of Hypnosis
Volksbank Rottweil
IBAN DE86 6429 0120 0031 9690 03
BIC GENODES1VRW

*for paying in EUR please use a currency converter to find the current rate

All prices are in USD

Please use the following information for wire transfer:

US: to pay via the American Account (USD)

Bank name: Citizens Bank
Wire transfer address: ROP480
One Citizens Drive Riverside, RI 02915
Account name: International Society of Hypnosis
c/o Laurence Sugarman
28 Hearthstone Road
Pittsford, New York,
14534-1155
USA

Account number: 621 256 606-6
Routing number: 0360761 50
Swift number: CTZIUS33

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