Name: Date:
Address:
City: State: Zip:
Telephone - Day: Evening:
E-mail:
Credit Card:
Credit Card # Expiration Date: (e.g. 10/06)
If this is a renewal please check here
Check here if you DO NOT want to be included in the NYSRA Member's Directory
Professional I (Certification from the ARCB) - $55 Annual Dues
Please insert Certification number: and submit a copy of your ARCB certificate with your application.
Professional II (Certification from a recognized Reflexology program) - $55 Annual Dues Please submit a copy of your School certificate with your application.
Both Professional I and Professional II Memberships include: Full voting power and representation NYSRA Newsletter Phone Referral Service Membership card Frameable certificate Associate/Student - $45 Annual Dues Attendance of at least one recognized seminar or workshop. School you are currently attending, or have attended: Associate/Student memberships receive: NYSRA Newsletter Membership card We are pleased to announce that NYSRA now has a practitioners referral list on the web site. This optional benefit is available to all professional members. The referral information will include: Practitioners (or Business name) Telephone number E-mail address Web Site address (if any) County(ies) of practice(s) For security purposes street addresses will be omitted unless explicitly instructed otherwise. The fee is $24 per membership year (July 1 - June 30). If your practice uses more than one locations each additional address will cost an additional $12, and must have the same name as the primary listing. Please include me on the Professional Practitioners list on the NYSRA web site. I am enclosing an additional $24 to activate my participation. I understand the duration of the listing runs concurrently with my membership. The county my listing is located is Make your check or money order payable to NYSRA and send this form and your payment to: NEW YORK STATE RELEXOLOGY ASSOCIATION PO Box 262 Scarsdale, NY 10583 Phone/Fax: 914.472.2521
Associate/Student - $45 Annual Dues Attendance of at least one recognized seminar or workshop. School you are currently attending, or have attended: Associate/Student memberships receive: NYSRA Newsletter Membership card We are pleased to announce that NYSRA now has a practitioners referral list on the web site. This optional benefit is available to all professional members. The referral information will include: Practitioners (or Business name) Telephone number E-mail address Web Site address (if any) County(ies) of practice(s) For security purposes street addresses will be omitted unless explicitly instructed otherwise. The fee is $24 per membership year (July 1 - June 30). If your practice uses more than one locations each additional address will cost an additional $12, and must have the same name as the primary listing. Please include me on the Professional Practitioners list on the NYSRA web site. I am enclosing an additional $24 to activate my participation. I understand the duration of the listing runs concurrently with my membership. The county my listing is located is Make your check or money order payable to NYSRA and send this form and your payment to:
School you are currently attending, or have attended:
Associate/Student memberships receive:
For security purposes street addresses will be omitted unless explicitly instructed otherwise. The fee is $24 per membership year (July 1 - June 30). If your practice uses more than one locations each additional address will cost an additional $12, and must have the same name as the primary listing.
Please include me on the Professional Practitioners list on the NYSRA web site. I am enclosing an additional $24 to activate my participation. I understand the duration of the listing runs concurrently with my membership. The county my listing is located is
Make your check or money order payable to NYSRA and send this form and your payment to: