First Name*
Last Name*
Email*
Phone Number*
Address*
City*
Upload Picture (to be displayed in Practitioner Directory as eligible)*
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State Province (US & Canada)
Zip/ Postal*
Country*
Personal or your Company Website
Company Address (if applying for Institutional membership)
Company/ Official Phone (if applying for Institutional membership)
Tell us your background in Psychosynthesis training*
Credentials (PhD, PsyD, MD, LCSW, MFT, LPC etc.)
State license | Certifications if practicing as a therapist
Years in practice as a psychotherapist or counsellor (as applicable)
Coaching Accreditation (as applicable)
Coach Accreditation Body (e.g ICF, EMCC)*
Level of Accreditation (e.g ACC, PCC, MCC or Senior Practitioner)*
Years in practice as a Coach (if applicable)
Locations where you practice*
Where you studied Psychosynthesis (Name of your Institute in full)*
Duration of your Psychosynthesis Program*
Evidence of your qualification A copy of your graduation certificate or a letter from your place of study, on headed paper, which confirms you have successfully completed and graduated from the course in full. Please only include the one relevant qualification - that is your core practitioner training. Make sure you enter your place of study and not who awarded your qualification (if these are different).*
Maximum file size: 5 MB
Brief description of practice and specialties (50 words or less)*
Include details in Practitioner Directory (note, this feature is only available for Professional, Lifetime and Institutional membership). *

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