Returning Member – Sponsors Application Form

    First Name (required)

    Last Name (required)

    Email (required)

    Phone (required)

    Credentials and Awards (required)

    Hypnotherapy Specialties (Example: Stress, Anxiety, Smoking, Regressions, etc.) (required)

    Approx. Year of Initial Membership

    Your Photo (max 10MB jpg/png)

    Name and Title for Photo Caption

    Business Name (required)

    Business Email (required)

    Business Phone (required)

    Business Address (required)

    City (required)

    State (required)

    Zipcode (required)

    Business URL (required)

    Business Logo (max 10MB jpg/png)

    Video URL (optional)

    Enter Text Below

    captcha

    After clicking the ‘Go to Payment’ button, you will be redirected to Paypal within 5-10 seconds.