Membership Renewal Form "*" indicates required fields 1Consent2Contact Info3Other Info4Maintaining RP Status5Maintaining RT Status6Teaching Statistics Membership Category*Additional pages will be added to form if RP or RT selected Associate Member General Member Recognized Practitioner Recognized Teacher External Member Teacher Emeritus Renewal Year*ConsentIn order to conform to the Personal Information Protection and Electronic Documents Act (PIPEDA), please check all boxes that apply for you.I give my permission for the TTNO: To collect and use my personal information. This information shall be used solely for the TTNO membership records, and to provide you with information about TTNO activities. It will not be released to outside parties except as required by law. To include my personal information in this year’s TTNO Directory of Members. To send me emails regarding TTNO business and upcoming events. To send me newsletters. To use images of my person on the website, in the newsletter. Contact InfoName* First Last Phone #*Member NumberADDRESS:* Street Address City Province / State / Region Postal Code / ZIP AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country EmailRequired if you want a confirmation of your renewal. EducationOptionalTherapeutic Touch Level(s) and/or Educational Credits attended in previous yearAdd additional entries using the (+)Name of workshop or EventName of TeacherDate (month/year) Add RemoveNotes / Comments: Additional levels or educational creditsStatus ChangeI would like to change my status to: Year of Grace Leave of Absence Retirement Branch Meetings I lead a branch meeting I attend branch meetings I would like to attend branch meetings LocationVolunteer SectionI would be willing to volunteer for: TTNO Event (e.g. Conference) Therapeutic Touch Awareness Week Task Group TTNO Committee under the Board of Directors TTNO Social Media TTNO Website Area of InterestReferral ServiceI wish to receive referrals from the: TTNO Referral Coordinator TTNO Website HOW TO MAINTAIN YOUR RECOGNIZED PRACTITIONER (RP) STATUSMaintaining RP Status I have met all the requirements for maintaining RP Status below A. YOU MUST BE A MEMBER IN GOOD STANDING* Paid (or about to pay) annual membership fee B. ATTEND A MINIMUM OF FOUR (4) BRANCH MEETINGS PER YEAR WITH A THERAPEUTIC TOUCH® PRACTICUM* Yes Each year, you must complete one or a combination of the Educational Options listed below to include a minimum of eight (8) hours of study specific to Therapeutic Touch® (TT) and Two (2) or more of the Therapeutic Touch Activities which may include attending additional Educational options. Check those that you attended in the previous year.C. EDUCATIONAL OPTIONS* Basic levels 1, 2, or 3 Foundations of upgrade (Tune-up) or Foundations of Therapeutic Touch® Transpersonal Nature of TT Transpersonal Nature of TT Upgrade (Tune-up) Attend a TTNO-approved Therapeutic Touch workshop or retreat Attend and/or facilitate a Professional Development Day(PDD). (Note to Teachers: If used for maintaining RP status, the same PDD cannot be used for maintaining Recognized Teacher (RT) status) Attend an event approved by the Teacher Liaison Committee as an Educational Component (Conference, Teachers Day, attend the full TTNO Annual Conference with the inclusion of a practicum session Attend a Therapeutic Touch event or workshop outside the province of Ontario Review an approved TTNO-TT resource and submit a review to the designated TTNO Reviewer(s) - must be pre-arranged with the Practitioner Liaison Chair Add your notes - an input box will open Education NotesD. THERAPEUTIC TOUCH ACTIVITIES* Attend four additional branch meetings per year where TT sessions are exchanged Write a submission for inTouch Participate/present on behalf of a Therapeutic Touch at a community event (e.g., health fair, Therapeutic Touch Awareness Week event) Serve on a TTNO committee Participate in a Therapeutic Touch study or research Regularly supervise Workbook Practitioner case studies (3-5 sessions/year) Serve as a mentor to a workbook practitioner An additional educational component (e.g., workshop or retreat) Offer Therapeutic Touch on a regular basis (e.g., hospice, long term care, hospital) - Please specify where using "Add your notes" below Add your notes - an input box will open Therapeutic Touch Activities NotesE. YOU MUST CONTINUE YOUR PRACTICE OF THERAPEUTIC TOUCH (these items are suggestions only) Offer at least four TT sessions per month - a total of 48 sessions per calendar year Receive Therapeutic Touch sessions on a regular basis Regularly evaluate and improve your skills in Therapeutic Touch Continue a program of self-healing and personal growth Pursue a regular reading program of Therapeutic Touch texts and articles HOW TO MAINTAIN YOUR RECOGNIZED TEACHER (RT) STATUSComplete the TTNO Teacher Self-Assessment Form*This form can be found at Index of Downloads under RECOGNIZED PRACTITIONER & TEACHER FORMS. You must be logged in to access it| I have completed the form TEACHING REQUIREMENTComplete ANY ONE of the following* Teach at least one Therapeutic Touch® workshop during the past year Facilitate a Professional Development Day Review a submission for the Teacher Liaison Committee (TLC) Audit a Therapeutic Touch workshop for another Recognized Teacher, completed the audit form and reviewed the audit with the workshop teacher. The completed form was submitted to the Teacher Submissions Review Coordinator. Develop an approved continuing education workshop PROFESSIONAL DEVELOPMENT REQUIREMENTEach year the Recognized Teacher must complete ANY ONE of the following:* Attend an eight-hour TTNO Teachers Day Mentor a student teacher or supervise their first workshop Serve actively on any TTNO committee or the Therapeutic Touch Awareness Week Task Group Serve as a representative on behalf of the TTNO on a Therapeutic Touch Network of Canada (TTNC) or Therapeutic Touch International Association (TTIA) committee Participate/present on behalf of Therapeutic Touch at a community event (i.e., health fair, Therapeutic Touch Awareness Week, mini workshop(s)) Present at a Teachers Day, the TTNO Annual Conference or other TTNO approved event Attend Therapeutic Touch specific workshop(s)/presentation(s) totalling a minimum of 8 hours (e.g. TTNC/TTIA education sessions, webinars) Complete a second item from the teaching requirement list (see above) TEACHING STATISTICSYearLevel 1 # of times presented# of studentsLevel 2 # of times presented# of studentsLevel 3 # of times presented# of studentsFoundations of Therapeutic Touch® # of times presented# of studentsTranspersonal Nature of Therapeutic Touch® # of times presented# of studentsApplication of the Inner Process of Therapeutic Touch® # of times presented# of studentsCONTINUING EDUCATIONAdd additional entries using the (+)Name of workshop or Event# of times presented# of students Add Remove
