Important Note: Due to differences in web browsers and their individual local configurations, the following form may not print correctly on your printer.  If this proves to be the case and you want to send in an application, please email roddy.duchesne@sympatico.ca.  I will send you a copy of the Invitation Package (Letter of Invitation, PHANA Launch in Brief, and Application Form) as email attachments in Rich Text Format.  If you have a reasonably recent wordprocessor, you will be able to print correct copies on your local printer.  If you are unable to open the attachment, or are dissatisfied with the way they print out, I will send you printed copies via regular mail.

 

PATHWORK HELPERS ASSOCIATION OF NORTH AMERICA (PHANA)
MEMBERSHIP APPLICATION

Please mail or fax your completed form to:  Lisa Willow, The Pathwork Foundation, PO Box 6010, Charlottesville, VA  22906-6010.  Fax: (434) 817-2661;  Tel: (434) 817-2660 or Toll Free within the US: (800) 728-4967;   Email: PathworkFound@aol.com

On receipt of your application form, Lisa will file your check and pass the form to the PHANA Council.  After acknowledging your application, Council will review it and contact you to confirm its acceptance of your application, and to obtain additional Register information.  In the unlikely event that Council finds itself unable to accept your application, it will contact you, giving its reasons, and will arrange for the Foundation to return your uncashed check.

If you have questions concerning the form and its contents, please contact Roddy Duchesne, Tel: (416) 925-6613; Fax: (416) 923-7923; Email: roddy.duchesne@sympatico.ca

1.   Contact Information

Name
Mailing Address
Phone # During Normal Business Hours	Phone # Outside Normal Business Hours
Other Phone #s if you wish to provide these, e.g. cell phone.	Fax #
Email Address
Web Site Address(es)

2.      Membership Information

Your Helper Status – Please Circle as Appropriate: Helper  --------  Apprentice Helper

Pathwork Region That First Recognized You As Having This Status

Pathwork Regions Of Which You are Currently a Member

Pathwork Chapters Of Which You are Currently a Member

Application Form - page 2

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• Home Page

PHANA Launch Document Links:

•   Detailed Contents Page

•  1. Overview

•  2. Why Set Up PHANA?

•  3. The Initial Launch

•  4. Financial Estimates

•  5. Register of Pathwork Helpers

•  6. Members Directory

Appendix 1 - Draft Invitation Package:

•  1.1: Letter of Invitation

•  1.2: PHANA Launch - In Brief

•  1.3: Application Form

Appendix 2 - Register Information Request

 

Latest Revision: April 21/02