Association of Noetic Practitioners ~ Application Form

Please fill out this application completely to join the Association of Noetic Practitioners (ANP). There is a $65 membership fee for the first year, and annual dues are $50 early-bird paid by March 1 each year or $65 after.  (Reminders are sent at the beginning of the year.)  

Joining the ANP allows you to attend the annual Noetic Conference and Advanced Workshop at a discount, attend Association meetings and monthly zoom book-clubs, and be part of our community of Noetic Balancing practitioners trained by Robert Waterman and Karey Thorne.  Upon approval, your name will be added to the online Association practitioner directory at:  https://www.noeticbalancing.com/practitioner-directory. 

If you have any questions please contact Win Hampton at 413-429-1897 or: winstonhampton@gmail.com.  

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Email *
1. Your Full Name *
2. Your Full Mailing Address *
3. Your Contact Number(s): Cell Phone and/or Work Phone *
Date of Birth: *
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4. Please describe your Major Field(s) of Work or Study (if any):

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5. Highest Degree Held (if any) 
Examples: PhD, EdD, PsyD, MA, MSW, BA, etc.

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6. Current Principle Employment:  (Position & Employer/Institution)

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7. PROFESSIONAL LICENSURE:  
Are you licensed or permitted by any state, federal, provincial or other board?  

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Required
If Yes - What is the Licensure?

Have you at any time been convicted of a felony, sanctioned by any professional ethics body, licensing board, or other regulatory body or by any professional or scientific organization?

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Required
If yes, please provide description/explanation:

8. ETHICS: 
Have you read the ANP code of ethics and you agree to abide by them?  Click here to View: https://drive.google.com/file/d/1xZl6ftfPh1suDP1um4J--XHbkKpcjUT4/ 

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Required

Do you currently use any illegal or non-prescribed drugs?

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Do you currently have a dependence on tobacco or alcohol?

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Required

If you answered yes to either of the above two questions please explain:

9. QUALIFICATION: 
Have you completed the 120hr Noetic Practitioners Program?

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Required

What date did you complete your Noetic Practitioner training?
(We may request a copy of your certificate of completion.)

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Who was/were the teacher(s) at that training?

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Is this your first application for professional membership in ANP?

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Required

How many hours do you practice Noetic Balancings on average, each month?  (Not necessary to have a current practice to be an Association member.)  

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10. PAYMENT: How will you paying your $65 Membership fee?
A. Online: https://paypal.me/quimbyamenti  (Please note that it is shared/named as the Quimby Amenti Scholarship fund.)

B. Or make out a paper check to: The Association of Noetic Practitioners.  Send to: Melanie Lanier, 21 Casa Hermosa, NE, Albuquerque, NM 87112

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Required

11. NOETIC BALANCING SELF STUDY

Please answer the following statements as briefly or in detail as you choose. 

 What is your intention in joining this Association?

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Please describe the ways you have practiced Noetic Balancings or any ways it may have influenced your life in the last year.

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Please describe ways you plan to practice Noetic Balancing or use it to your advancement in the next year.

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Please describe any current spiritual practices or meditations you do.

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APPLICANT SIGNATURE.  Please type your full name below as signature.

As an ongoing commitment to my membership in the Association of Noetic Practitioners I agree to continuing educational experiences that deepen my awareness and skill in the area of Noetic Balancing. Examples: Advanced classes with Robert Waterman and Karey Thorne; seminars or classes in a complimentary field; spiritual growth workshops or classes. 

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Date Submitted: *
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THANK YOU!  You will receive an email confirmation when your application is approved, be added to the practitioner directory and get information on upcoming bookclubs and gatherings.  If you have any questions please contact Win Hampton at 413-429-1897 or: winstonhampton@gmail.com.  
A copy of your responses will be emailed to the address you provided.
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