Become a Member of the IIRT
This application form is for all applicants who wish to join The International Institute for Reiki Training. To join, simply fill out this form and submit your application by one of the following methods:

ONLINE: Simply fill out the form below and click 'SUBMIT'
or
POST TO: PO Box 733 Byron Bay NSW 2481 Australia (click on the link: IIRT Membership Registration Form (102 kb)
or
FAX: Download, print out and complete form below (click on the link below - (click on the link: IIRT Membership Registration Form (102 kb) and fax to: +61 (02) 6685 4823  - Press the start button on your machine after dialing the number.

IIRT Membership Registration Form (102 kb)

Membership Special Offer: *FREE BOOK OFFER!
Become a member this month to receive a free copy of "Reiki Satsang - 200 Q and A on Reiki" valued at $32.95
 * Excludes International applicants. Available for Australian applicants only.

IIRT Online Membership Registration Form

*Manditory text fields

Title DR MISS MR MRS MS

First Name *

Last Name *

Email *

Address *

City *

State *

Postcode *

Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CâTE D'IVOIRE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

Phone Number *

Mobile Phone Number *

Did an existing IIRT member refer you to our Membership (referral program)? If so please provide IIRT Member Name

As well as their Member number

How did you hear about us? (PLEASE SPECIFY) *

Nova

Living Now

Innerself

Word of Mouth

Via an Association

OAMPS

Surfing the Net

Other

For Reiki Applicants

Your current level/s of Reiki Certification

Your initiating Reiki Teacher/s

Which Reiki styles have you learnt?

For Non-Reiki Applicants

List any other Certificates or Qualifications that you hold

Remember to please send us copies of any relevant Certificates or Qualifications that you hold to support your application. *Photocopies or scanned images are sufficient. Certified copies are not required. Do not send originals.

You may attach scanned image(s) of your certification documents (JPG or GIF files, 3Mb Limit)

SAVE PAPER, SAVE OUR PLANET! Would you like to receive your Certificate via email? *

Yes -- please email my welcome pack

No -- please send in the post

MEMBERSHIP FEES 1 Year Membership is $55 Join Between July and September: $55 Join Between October and December: $50 Join Between January and March: $45 Join Between April and May: $40 Join in June: $55 (Valid for 13 months)

I am joining this month to qualify for a free copy of "Reiki Satsang" Postage and Handling: $4.95* * free book not available for international applicants. See Reiki Shop for book orders.

AUTO-RENEW -- The Hassle Free Way to Save YOU Time at Renewals! DIRECT DEBIT REQUEST- Please retain my credit card details and automatically debit my credit card on June 30th each year to automatically renew my membership. Note: By ticking this option you will automatically have your membership renewed and your new membership certificate will be issued to you at renewal time. Your renewal fee will appear on your credit card statement.

Name on Card *

Card Number *

Card Expiry * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Card Type * Visa Master Card American Express

Amount *

Enter Word Verification in box below * (re-type the letters from the green box, in the white box below it)

* indicates mandatory fields Note: All membership registrations are subject to our Refund Policy