Practitioner Member Application
Application directions for Form C – Make sure to follow these directions
Requirements for Practitioner status are 180 hours of formal documented study of traditional Thai massage (Nuad Boran, Thai yoga massage, etc.) plus a minimum of 50 documented practice sessions. The study must have been completed in traditional style, on the floor. At least one year (and no more than 3 years) must have elapsed since your first study. Foot massage, reflexology, orhybrid forms of Thai massage are not acceptable for this level of membership.
Detailed directions for completing Form C
(As you enter information, the response areas will automatically expand if you require extra space. Use the tab key to move from one column to the next. Use the backspace or delete key to move lines up.)
If you are already a member of THAI, enter your membership number. If not, leave that space blank. Enter the date of application. Enter the name of the teacher or school with whom you have completed the majority of your study.
Section 1 – Personal Information
Fill in all the requested information in the white spaces above each category.
Credit Card Information: To pay by credit card, enter your credit card information here (MC or Visa). Enter the number, the expiration date, indicate if it is MasterCard or Visa, and enter the 3 digit verification code on the back of your card. All payments must be made by credit card (MasterCard or Visa). THAI does not accept payment by cash, check or money order.
Section 2 A – Areas of Interest & Study
2.1) Describe your interest in Thai massage or related Thai healing arts
2.2) Explain why you wish to be a Practitioner Member of the Thai Healing Alliance (THAI)
2.3) As a member of THAI, you must pursue continuing education courses totaling a minimum of 30 hours every two years. Describe ways in which you expect to continue your ongoing study.
Section 2 B – Documented Study
In the white space below each heading, list the course name, teacher and/or school, location, date, and total hours of each course you have studied. (Use the tab key to move from one column to the next) Any combination of classes or workshops qualify for Practitioner level status, but your total hours of study must equal or exceed one hundred eighty (180) hours, and you must have studied any length of time with at least one THAI-approved instructor or school.
REMEMBER: You must submit photocopies of your certificates or transcripts with your application. If you haveany undocumented study hours (no certificates for your study) your application will be reviewed and assessed by the THAI Membership Committee in order to determine your eligibility as an Advanced Practitioner in THAI.
Section 2 C – Hands on Practice Documentation – minimum of 50 logged practice sessions
Read the declaration, and indicate your consent by entering your name in the space provided.
REMEMBER: You must include documentation of a minimum of 50 practice sessionswith your application. A sample of THAI Form L is enclosed with this application.You may use THAI log (Form L) or any form of your own, provided that the log is a double sided sheet with space for recording a minimum of ten sessions per page. Each page must be signed or initialed by the practitioner, and must contain the first name of the client, the date of the session and the duration of the session. Written descriptions of each session must include the following: a) Symptoms and complaints b) Positions used (supine, prone, side, seated) and specific techniques employed, and c) General observations and findings. In addition, other comments and any self-care recommendations may be noted.
directions continued next page…
You must also include a blank copy of your client intake form with your application materials. This is the form that you use to record your clients’ health history and other information.If you do not have your own, you may request a copy of THAI’s intake form. Write to and we will send one to you by e-mail.
Section 3 – Professional Information
3.1 - 3.4 Answer yes or no by entering an “X” in the corresponding box
3.5 Describe your interests in ongoing study, and any plans you may have to continue your study and practice.
Certify the information by entering your name and the date at the bottom of the page.
On the next page, indicate your consent to uphold the THAI Code of Ethics by entering your name and the date.
Submitting and processing your application
When you have completed the application, send it by mail, along with your credit card information and all required documents to: THAI P.O. Box 16247Chapel Hill, NC27516USA. Credit cards only for payment. Do not send cash or checks.
Remember to include photocopies of all your supporting documentswith your application(certificates of documented study, logged practice notes, etc.).
If for some reason, more information is requested in order to process your application, a THAI representative will contact you and request the additional information. Your payment will not be processed until your application is approved.
Thank you for your interest in THAI. We hope to welcome you as a Registered Thai Therapist !
REMEMBER TO:
1. Complete all the information on this application including your credit card number and expiration date
2. Type or sign your name first in Section 2 (C) and again after the THAI Code of Ethics
3. Include a blank client intake form with this application
4. Include notes and logs of 50 practice sessions (10 session notes per double-sided page, for a total of 5 pages)
Please do not send these directions with your application. Thank you.
If you have any questions or if you need assistance completing this form, contact
Date of application:(month / day / year)
Remember to include all supporting documents with your information.
Section 1: Personal Information Enter information in the white spaces belowfirst name / last / surname / middle / other
business name (if applicable) / year of birth (yyyy)
address
city / state / province / zip / postal code / country
e-mail / web site / telephone
As a member of THAI, your agree that your contact information will be listed in the members-only section of the THAI web site, and your name and town will be listed in the THAI member list on the home page.Membership in THAI renews automatically by credit card every two years.
Method of application and paymentPractitioner
$175 two-year fee / Send your application and payment by regular mail.
Enter your credit card information in the spaces below.
Enter your credit card information below,and send all materials to: THAI P.O. Box 16247Chapel Hill, NC27516 USA
Credit Card Information Enter your information below if you are paying by credit card.Discount may be available. See details on homepage of the THAI web site.
credit card number / exp. date (mm/yy) / Master Card or Visa? / verification # *
* The verification number is the last three numbers on the back of your credit card, above your signature.
Section 2: Related Study and Practice -- (A) Areas of interest and study2.1) In the space below, describe your ongoing general interests in Nuad Boran and Thai healing arts.
2.2) Describe some personal and/or professional reasons you have chosen to apply for membership in THAI.
2.3) THAI members must pursue continuing education courses totaling a minimum of 30 hours every two years. Describe ways in which you will most likely accomplish this ongoing study.
(B) Documented study
List the name of each course or program you have studied, the name of your instructor or institution, location, date of completion for each curriculum or course, and total hours studied. Total formal study for Practitioner level must equal or exceed 180 hours. Some of this study must be with a THAI-approved instructor or school. Remember, you must include photocopies of your certificates of formal study with your application, and send all materials by mail.
course nameteacher or institutionlocationdatehours
(C) Hands-on practice documentation, client logs and intake formIn submitting this document, and with your name below, you declare on your honor that you have performed a minimum of 50 hours of uncompensated hands-on practice carried out after the formal study documented in section 2(B) above. You further declare that you will keepdetailed written logs of all your future Thai sessions.
Enter or sign your name
Remember to submit all materials with this application:
You must submit a blank copy of your client intake form with this application.You must also submit client practice notes for 50 sessions with this application. You may use THAI Form N, or any other form you wish, but please be sure to attach no more than 5 double-sided pages (10 session notes per page). If you have any questions or if you need assistance, contact
Section 3: Professional InformationPlease answer the following questions about your practice and ongoing study. / Yes / No
3.1) Do you belong to any other professional organizations?
If yes, list them here:
3.2) Are you a licensed (western) massage therapist?
If yes, list state / province and country, and your license number here:
3.3) Are you licensed or certified by any other professional organization?
If yes, please list all appropriate information here:
3.4) Do you currently maintain personal liability insurance for your Thai massage practice?
3.5) In the space below this box, describe ways in which you plan to continue ongoing study of Nuad Thai and related Thai healing arts. (THAI requires that you study a minimum of 30 hours of Thai continuing education every two years.)
Thai Healing Alliance Ethical Code Agreement
1. DILIGENT STUDY
I agree to keep my practice up to date by seeing clients regularly, practicing, and pursuing studies through continuing education and refresher courses.
2. PRIVACY & CONFIDENTIALITY
I agree to respect the privacy and the confidentiality of any and all clients from now into the future. I further agree to not disclose to a third party any personal information a client may confidentially share with me.
3. REASONABLE COMPENSATION
I agree to charge a fair price for an excellent service, and to set fees for my services commensurate with my experience and expertise.
4. RESPECT FOR OTHER PRACTITIONERS
I agree to not coerce or manipulate clients of another practitioner to receive my services.
5. MAINTAIN HUMILITY
I agree to market myself honestly within the parameters of my experience, and to represent myself only at the level of membership I maintain according to the policies of the Thai Healing Alliance.
6. SEEK GUIDANCE
I agree to continue to hone my skills as a practitioner by pursuing continuing education, taking courses and workshops, reading, doing research and engaging in work and study with other practitioners. I understand and acknowledge that my practice is a life-long pursuit of knowledge.
7. MAINTAIN DIGNITY
I agree to uphold a high standard of professional ethics, and to avoid behavior that would tarnish the reputation of traditional Thai healing arts. This includes refraining from any and all sexual massage, and not engaging in Thai massage when either party is under the influence of alcohol or drugs.
8. PROFESSIONAL INTEGRITY
I agree to not formally teach nuad boran to any person unless I am an experienced teacher and practitioner and have been recognized by THAI or by another body in Thailand or the country in which I live and practice.I also agree to make clear to my students that the practice of Thai massage is subject to all local laws and ordinances.
9. BE GRATEFUL
I agree to maintain a spiritual approach to my professional healing practice, and to continually work through my practice for the betterment of myself, my clients and mankind.
With my name below, I certify that all the information in this application is correct, and I agree to abide by and to uphold this code of ethics as key to maintaining membershipin good standing with the Thai Healing Alliance International.
Enter yourname / dateSAMPLE THAI Form L - Make 5 double-sided photocopies to record your 50 sessions, or use any form of your choice.
page / ofPractitioner name
date(d-m-y) / client name / total session time
Session notes
date(d-m-y) / client name / total session time
Session notes
date(d-m-y) / client name / total session time
session notes
date(d-m-y) / client name / total session time
session notes
date(d-m-y) / client name / total session time
session notes