Practitioner Index Request Form

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Practitioners & students studying their modality can have their details listed for a one off fee as follows:
$50.00 for first modality, then $20.00 for each subsequent modality wishing to be registered.

Please fill in the following form and hit the SUBMIT button below to apply. If successful an electronic invoice through Paypal will be emailed to your email address. Upon payment and submission of your qualifications your details will be listed in the directory. Please pdf a copy of your qualification and email to directorylistingrequest@equinoxholisticservices.com

Please allow up to seven days for your request to be processed as the emails are not monitored on a full time basis.

If you wish to email your request instead, please follow the above and below requirements and email to: directorylistingrequest@equinoxholisticservices.com

HOLISTIC MODALITY DIRECTORY PRACTITIONER’S INDEX REGISTRATION FORM

Fields marked with a * must be filled in
	Name:	*
	Business Name:	*
	Suburb(s):	*
	Full Address (optional):
	Modality(s) you wish to be listed under:	*
	Contact Number(s):	*
	Web Address (optional):
	Email Address:	*
	Human Verification: What is four plus three ?	*

In filling out and submitting this form you are also agreeing to the following understandings:
1/ All information submitted is true and
2/ All qualifications forwarded with payment have been obtained by the person who is making this application and
3/ That you work with the highest intent within your nominated modality and not work in a manner that brings the modality and therefore its other Practitioner’s into disrepute and
4/ That the Authors of the Website have the final determination as to whether these details are displayed on the website

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