Please type or print this form completely. Email to rigsby@pathworktexas.org or mail to: Jan Rigsby, 301 East 4th St. Apt 328, Austin TX 78701. If you have questions concerning this form and its contents, please contact Jan by email or at 512-215-2544. If you email the document with all questions answered, it will be accepted as if it were signed. For new applications, information about your original Helpership Training certification(s) and/or your current Pathwork affiliations is crucial to determine your status as a Pathwork Helper. Upon receipt of new applications, PHANA Council will contact you to confirm council’s acceptance of your application and follow-up with you about the wording of your entry in the Register of Pathwork Helpers.
Contact Information
Name _____________________________________________________________________
Mailing Address _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Home Phone # and calling preferences _____________________________________________
Business Phone # and calling preferences _____________________________________________
Other Phone #’s (types & preferences) _____________________________________________
Email Address ________________________________________________________________
Website Address ________________________________________________________________
Membership Information
Helper Status (Check one) __ Helper __ Apprentice Helper
Pathwork region that first recognized you as having this status: _______________________________________
Pathwork regions, chapters and/ or groups of which you are currently a member:
__________________________________________________________________________________________
(Circle the one you consider to be your primary affiliation.)
Membership Criteria
The following criteria are based on the views expressed by respondents to the 1999-2000 survey of US/Canadian Helpers. Note: The footnotes contain “hotlinks” to help you learn more about the criteria.
1. I base my work on the Pathwork Guide lectures.
2. I have made a Stage IV commitment as recommended by the Guide in AD6: Stages and Questions or a commitment that is equivalent in substance even if it is worded differently.
3. I consciously incorporate the Pathwork into every aspect of my life.
4. Honoring the law of brotherhood, I do continuing personal work including individual and/or group process work. In addition, if I have workers, I am in peer or paid supervision with a recognized Pathwork Helper or other person approved by a recognized Pathwork Region or Chapter or by PHANA.
5. I honor the International Pathwork Foundation copyright and trademark policies.
6. I am willing to engage in cooperative personal dialog with other Helpers, with the Foundation and its Councils and Committees, with the North American Pathwork Association, and with PHANA. I am willing to be constructively confronted within the Pathwork community.
7. I agree to train others to become Pathwork Helpers only within, or in cooperation with, a training program recognized by the North American Pathwork Association.
8. I commit to conduct myself in ways that build trust, confidence, and respect in the title Pathwork Helper. To this end, I commit to maintaining standards of social, professional, and ethical behavior that meet or exceed social norms. I have read the PHANA Code of Conduct and agree to abide by it.
Please note below any of the above criteria that you do NOT meet/accept. Provide reasons or other information that you find relevant. If there is insufficient space below, continue on the reverse or another page. Council can give case-by-case consideration to applicants not meeting all the criteria. Please understand, however, that case-by-case consideration takes time and will result in delay.
Signature: _____________________________________ Date: ______________________
Please fill out page 2 in order to authorize specific membership details listed at www.phana.org
Register of Pathwork Helpers
Review the Register of Pathwork Helpers at www.phana.org and tell us how you wish to be listed. (Check ALL that apply.)
__ No changes to my current listing.
__ Create a listing for me.
__ List me on the list of helpers who are: __ Actively Seeking Workers __ Not Seeking Workers At This Time
__ Use the current membership information provided on this application to correct my contact information.
__ Change my personal paragraph to the exact wording that follows here:
__ Other: Please describe the type of change you want to your listing and the exact wording you want in the listing.
Payment AmountIn addition to your annual membership fee, PHANA invites you to make tax-deductible donations to PHANA or The Pathwork Foundation. In either case, The Pathwork Foundation will provide you with a receipt for tax purposes.
Item Amount
Tax Deductible Donation to PHANA $
Tax Deductible Donation to The Pathwork Foundation $
Total $
Manner of Payment
Option 1: I enclose a check for $ _______________ payable to “The International Pathwork Foundation.”
Option 2: You may pay online using the IPF site, www.pathwork.org. The specific page site is
http://www.pathwork.org/php-bin/ecomm4/categories.php?category_id=18
Option 3: Please charge $ _______________ to my Visa/MasterCard credit card:
____ Visa ____ MC# _________________________________________ Exp. Date: _____ / _____ / _____
Name as it appears on the Card: ___________________________________________________________
Signature: _____________________________________________________________________________
Thank You!