Membership Application Please complete and submit this membership application form. Step 1 of 3 33% Section 1: Biographical Information Both new and renewal applicants should complete this section.Date MM slash DD slash YYYY Type of Membership:(Required) New Renewal Name(Required) First Last Address Street Address Apartment Number City / Town State / Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail(Required) May we have your permission to post your above email address on the NAFA website for public view? Yes No Section 2: TrainingIf this is a renewal membership, would you like to update any information in this section? (New members should not respond to this question.) Yes No If you answered NO, click the "Next" button below and complete the questions in Section 3: Dues & Payment. Otherwise, please complete the following questions.Please check levels of FIE training completed: Basic I Basic II Standard Level I Standard Level II Standard Level III LPAD I LPAD II Basic Trainers I Standard Trainers I Standard Trainers II LPAD Trainers I LPAD Trainers II Other What are your special area(s) of Interest in FIE?ATC Affiliation (if applicable) Do you want to be listed as a Practioner on the NAFA website? Yes No If yes, in which geographic area(s)? East South Midwest West Canada Do you want to be listed as a Trainer on the NAFA website? Yes No If yes, in which geographic area(s)? East South Midwest West Canada For which levels? Basic Standard Section 3: Dues & Payment Membership dues are for one year: September 1 to August 31Dues Individual: $50 Couple: $50 Student: $25 Institution (10-30): $300 (Add members below) Institution Name City / Town, State Email Practitioner Trainer Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. How do you plan to pay for your dues? Check / PayPay PayPal / Credit Card Important: Your application is not complete until you submit this membership application form and pay your dues. After you submit this form, a page will appear which will provide information about how to pay your dues.We appreciate your help in expanding our membership and are sure that you will be glad you joined the North American Feuerstein Alliance. We hope you will join us for our monthly webinars. Watch the calendar for dates, times, and topics!CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
