Application Form p.2

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Application Form
Page 2 of 2

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.

3.      Membership Criteria

The following criteria are based on the views expressed by respondents to the 1999-2000 survey of US/Canadian Helpers.

(a)

I base my work on the Pathwork Guide lectures.

(b)

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.

(c)

I consciously incorporate the Pathwork into every aspect of my life.

(d)

I am in peer or paid supervision with a recognized Pathwork Helper or other person approved by a recognized Pathwork Regional Organization or by PHANA.

(e)
I honor the Pathwork Foundation copyright and trademark policies. [1]

(f)

I am willing to engage in cooperative personal dialog with other Helpers and the Foundation and its Councils and Committees, and am willing to be constructively confronted within the Pathwork community.

(g)

I agree to train others to become Pathwork Helpers and Counselors only within, or in cooperation with, a training program recognized by the Pathwork Foundation, or as authorized by PHANA.

Please note below any of the above criteria that you do NOT meet/accept, providing reasons or other information that you feel relevant. If there is insufficient space below, please write on the reverse of this sheet.

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.

Please sign below, indicating that you meet/accept all the above criteria except as you have noted:

Signature:

Date:

4.   Payment

In addition to your annual membership fee, PHANA invites you make a tax-deductible donation. The Pathwork Foundation will provide you with a receipt that you can use for tax purposes.

Item

$

Annual Membership Fee: $100 for Helpers; $75 for Apprentice Helpers

Tax Deductible Donation

Total

Please enclose a check^[2] for the above total, payable to “The Pathwork Foundation.”

Thank You!

Application Form - page 1

[1] Please click here for a summary statement of these policies. This summary can also be found at the end of each 1996 Edition Lecture and each Unedited Lecture. A full statement of these policies can be found on the Complete Lectures of the Pathwork CD-ROM, and/or can be obtained from the Foundation Office.

[2] It is currently administratively difficult for the Foundation to accept credit card payments for membership fees.

• 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

(a)	I base my work on the Pathwork Guide lectures.
(b)	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.
(c)	I consciously incorporate the Pathwork into every aspect of my life.
(d)	I am in peer or paid supervision with a recognized Pathwork Helper or other person approved by a recognized Pathwork Regional Organization or by PHANA.
(e)	I honor the Pathwork Foundation copyright and trademark policies. [1]
(f)	I am willing to engage in cooperative personal dialog with other Helpers and the Foundation and its Councils and Committees, and am willing to be constructively confronted within the Pathwork community.
(g)	I agree to train others to become Pathwork Helpers and Counselors only within, or in cooperation with, a training program recognized by the Pathwork Foundation, or as authorized by PHANA.
Please note below any of the above criteria that you do NOT meet/accept, providing reasons or other information that you feel relevant. If there is insufficient space below, please write on the reverse of this sheet. 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.


Please sign below, indicating that you meet/accept all the above criteria except as you have noted:
Signature:	Date:

Item	$
Annual Membership Fee: $100 for Helpers; $75 for Apprentice Helpers
Tax Deductible Donation
Total

[1]	Please click here for a summary statement of these policies. This summary can also be found at the end of each 1996 Edition Lecture and each Unedited Lecture. A full statement of these policies can be found on the Complete Lectures of the Pathwork CD-ROM, and/or can be obtained from the Foundation Office.
[2]	It is currently administratively difficult for the Foundation to accept credit card payments for membership fees.