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EMF Balancing Technique® |
This form serves two purposes - Information to post online
to the public (the way the public contacts you), and information for the EEI
data base (the way EEI contacts you).
Please submit this form in the same envelope with your original signed License Agreement and payment for yearly fee if you wish to be listed on the Multi-Language www.EMFWorldwide.com web site - The official English version - The EMF English Language Mirror Site. The ONLY comprehensive source of information in English, providing consistent information to all English speaking visitors on the Internet. We highly encourage you to send your information so that your name can appear with all the other licensed Practitioners. This is an important outlet for you to promote your practice
This entire form MUST be TYPED and a hard copy submitted to EEI |
*Part A - Web Site Listing Information (optional)
*If you do not wish to be listed
at this time go to Part B.
First
Name
Last Name
Address:
City, Province, or Canton:
State:
Zip Code or
Postal Code: Country:
Email:
Telephone Number:
(include country code if outside of USA)
Level: Please
check all that apply:
Advanced Certified Practitioner
Phases I-VIII Certified Practitioner
Accredited Practitioner Phase I-IV
Accredited Practitioner I-IV and Practitioner V-VIII
Part B – EEI
Data Base Contact Details
If your contact details for EEI are the same as Part A check here
If your contact details are different from Part A, please TYPE below how you
wish to be contacted by EEI
First Name
Last Name
Address:
City, Province, or Canton:
State:
Zip Code or
Postal Code: Country:
Email: Telephone Number:
Part C – Yearly Web Listing:
Basic Listing - Includes information from Part A only. $22.00usd for 1 year*.
Basic Listing & Link to your personal Website - $55.00usd for 1 year*.
Web Site Link:
Payment Method:
Check in USD, Drawn on a US Bank
(please
include the check with this form, payable to EEI)
Transfer to Germany Account(Click
Here for Transfer details)
USD Money Order(please
include the money order with this form, payable to EEI)
Credit Card (Visa,
Mastercard, Amex, or Discover)
Credit Card Number Name on Card
Expiration Date