Membership Application PRACTITIONER Category

Transcription

1 Office use only Membership Application PRACTITIONER Category Member #... Invoice #... Date... To ensure accuracy of your details please print clearly Please note: There is a one-off joining fee of $35 due with application. You will receive an invoice for your category of membership. Name:... Address:... Suburb:.. City:.... P/C. State:.. Country:..... D.O.B.:..... Tel: W.. H.....Mob... Fax:.. *..... *If you don t have an account we encourage you to ask a friend or family member to either receive correspondence on your behalf OR to establish a free hotmail, gmail or yahoo account for you. An increasing percentage of our information is now distributed via to conserve money, trees and human resources. We are no longer able to provide a printing and postage service to members without . honours the lineage bearers and founders of practices as the authority for their own practice; each practice has its own descriptions and guidelines. In, we honour the place of each form of practice. Section A Details of Reiki training Many forms of healing, with a multitude of origins, are practised throughout Australia. A number of different branches or forms of Reiki are also taught and practised in Australia. As a Reiki membership association, has a responsibility to ensure that applicants, particularly for professional membership categories offering services to the public, actually practise a form of Reiki. Although there are differences among various branches/forms of Reiki practice, all Reiki practices stem from the teachings of the founder, Mikao Usui, and share some core elements such as initiation, precepts and treatment. The following section seeks information regarding these elements in regard to your practice. 1 Have you completed training and initiation in both Reiki 1 and 2 or the equivalent? This is a requirement for treatment practitioner categories of membership. Yes No 2 Were you physically present with the Reiki master giving the initiation/s? Initiation in person is a requirement of this category Yes No 1

2 3 Is your lineage of initiation traceable to Mikao Usui? ** (Your lineage of initiation is the direct line of initiating masters connecting you, through the Master who initiated you at the highest level you have completed, to Mikao Usui). Yes No Don t know 4 What is the lineage of initiation that was described to you? ** Please include the details of your lineage of initiation to the best of your knowledge. The details of my lineage of initiation, beginning with Mikao Usui and concluding with my own initiating Master, are: Mikao Usui Many people have received training in more than one form of Reiki practice. Please include details of all training in Reiki you have received, adding an additional page if necessary. Level Date initiated Reiki Teacher/Master Form/Practice of Reiki Section B Details of your practice of Reiki Applicants who practise a recognised form of Reiki are automatically eligible, conditional on meeting other membership requirements, for membership in s treatment practitioner categories. This section relates to your form or branch of Reiki practice. ** If you are unable to provide some of the requested information regarding your lineage of initiation (above) or the form of Reiki that you practise, or if the form of Reiki practice you describe is not known to Reiki Australia, you may be asked to provide additional information so that your practice can be matched against known forms. An additional processing fee of $35 will be charged for this service. 6 What is the name of the practice? If you have been trained in more than one form of Reiki, what is the name of the form that you use when you provide Reiki treatments? 7 Does this practice have a spiritual lineage? ** (The Spiritual Lineage is traceable from Mikao Usui and his successors to the person today, acknowledged as the lineage bearer of a particular form of Reiki practice). Yes No Don t know 2

3 8 Please name the person who is acknowledged as being the authority for the description of this practice? This person is likely referred to as the Lineage Bearer, Founder or Head of Practice, Grand Master. 9 Were you taught how to give yourself a Reiki treatment? Yes No 10 Does this form of practice include principles or precepts? If so, please list them as they were taught to you Please briefly describe the history/origins of the practice as you were taught by your Reiki Master 3

4 Section C Details of your treatment practice Reiki treatment practitioners must be able to clearly describe their Reiki treatment and any additional services offered, in order for clients to give informed consent. Gaining informed consent prior to the Reiki treatment is a requirement of the Code of Ethics as well as of the legally binding NSW Code of Conduct for Unregistered Health Practitioners, which is expected to be introduced nationally in the very near future. To give informed consent a client must have sufficient information to understand the nature, the potential benefits and any risks of their choice of treatment. In this section you are asked to provide details of your Reiki treatment. The following checklist will provide you with an indication of the various aspects of your treatment that should be explained to your client prior to commencing treatment. Do you work with your hands on the body? YES NO Sometimes Comments/explanations/examples Do you work with your hands off the body? Are your treatments conducted with the client seated? Are your treatments conducted with client lying down? Are initiations/blessings included as part of your treatment practice? Do you provide distant/absent/remote Reiki treatments? Do you include additional practices within a Reiki treatment, e.g. psychic/intuitive reading, the use of crystals or oils, or other healthcare modalities? If so, please list them. Do you have a particular treatment procedure for chronic conditions? Do you have a particular treatment procedure for acute conditions? Do you seek any information from a client the first time you see them, e,g, contact details, reason for attending, medication they are taking? Do you provide information to a first time client about what they might experience during, and possibly after, their Reiki treatment? Do you keep records of Reiki treatments you provide? 4

5 Treatment of the genitals or breasts Where there is a clear clinical basis for placement of hands over the genitals or breasts as part of the Reiki treatment, the Reiki treatment practitioner must obtain signed consent from the client prior to treatment; the client can then receive treatment appropriate to their condition. These steps are essential to prevent misunderstandings and the perception of inappropriate touching or sexual misconduct. Do you treat the breasts or genitals, either on or off the body? YES NO Sometimes Comments/explanations/examples Hand positions for Reiki treatment YES NO Sometimes Comments/explanations/examples Do you generally use a routine set of hand positions for your treatments? Are your hand positions mainly determined by intuition during a treatment? If you use a set of routine hand positions, please use circles to show positions for a basic treatment. Also mark any additional hand positions you use, in a different colour if possible. Front Back 5

6 Section D Business Details 1 Are you already established in a public/professional practice of Reiki? No Yes. Please specify where. e.g. home, clinic... 2 ABN and Business name if applicable: Do you hold current public liability and professional indemnity insurance for the Practice of Reiki? Holding current insurance is a requirement for this category Yes, please specify insurance company name:..... Policy No:......Expiry Date: No, please send me insurance information 4 What other health-related professions are you qualified in? None Nursing Massage Naturopathy Homeopathy Psychology Counselling Other. 5 Website listing particulars Visit s website directory listing for reference. Please print clearly. State:.....Post Code...Location:... Name: Business Name:... Form/Branch/Style of Reiki Practice... Phone No 1:...Phone No 2: Your website URL: 6

7 Section E Agreement I understand that my eligibility for membership is dependent on this application and relevant supporting information being accepted, and on my agreement to uphold s Mission, Vision, Values and Aims. I agree to uphold s Mission, Vision and Values* and support the following organisational Aims: Promotion of Reiki as a spiritual practice and healing art Community connection and enrichment for Reiki practitioners and masters Professional development for Reiki practitioners Integration of Reiki into mainstream facilities I confirm that I have read and agree to abide by the Code of Ethics I confirm that I have read and agree to abide by the Code of Professional Conduct Signature:... Date:. Please print name in full:... * Mission, Vision and Values, and Code of Ethics and Code of Professional Conduct are available for reference on our website Section F Supporting documentation I enclose the following documents to support my application: JP Certified copies of my Reiki Certificate/s Copy of Insurance Certificate of Currency (if applicable) Completed Payment Option Form (last page) Section G Participation Particular interests sought through Membership; please tick as many as applicable Insurance Reiki community connection Industry representation Professional Development Keeping abreast of Reiki related issues/events Networking Other I am interested to be active and involved in the organisation please contact me for further information 7

8 Section H General information How did you find out about? Friend/Colleague Initiating Reiki Master Yellow Pages Website Advertising, in which publication?... Other One-off Joining Fee PAYMENT Form Non-refundable administration fee You must complete the application process within 2 months, after which time your application will be closed and a new application will be required. Name Joining Fee of $35 paid via: Cheque Money Order Direct Deposit Credit Card Card details: Visa Mastercard Bankcard Card number I I I I I I I I I I I I I I I I I I I I Exp date Name on Credit Card Signature Direct Deposit: Westpac Bank Australia BSB: Account No: Account Name: (Please quote your name when paying by direct deposit) Payment Ref. No:... Return with your payment to: P.O. Box 270 Landsborough QLD 4550 Or Fax to Office Use only Nomination by paid up member. Nomination by paid up member. 8