HCA National Hypnotherapists Register Registration Form HCA National Hypnotherapists Register Application For Listing Email Address * Suburb of Primary Practice * List the suburb of your main practice Suburb of Secondary Practice (if applicable) List secondary suburb. Note: only suburbs when you have a physical practice can be submitted. This will be checked with your member association. Postcode * Primary suburb postcode Name * Practice Name (if applicable) Practice Address Practice Address Only add your practice address if you want it listed on the register. If you don't require an address, leave blank Only add your practice address if you want it listed on the register. If you don't require an address, leave blank Practice Address City City State State Postcode Postcode Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number * No spaces please. Phone number where clients can contact you. Website/URL Your business website (not Facebook / Natural Therapy Pages) Primary Association Membership (check one box only) * Australian Association of Clinical Hypnotherapy and Psychotherapy Guild of Australian Hypnotherapists International Strategic Psychotherapists Association Professional Clinical Hypnotherapists of Australia You must be a current member of AACHP, GoAH, ISPA, PCHA to be listed on the HCA Register Membership Level * ProfessionalRegistered ProfessionalClinicalFellowOther Note: student members and non-practicing members of associations are not eligible for listing on the register Association Membership Number AACHP, GoAH, ISPA, PCHA membership number if known Secondary Association Membership (if applicable) Australian Association of Clinical Hypnotherapy and Psychotherapy Guild of Australian Hypnotherapists International Strategic Psychotherapists Association Professional Clinical Hypnotherapists of Australia You must be a current member of AACHP, GoAH, ISPA, PCHA to be listed on the HCA Register Qualifications * Please list recognised qualifications, one per line Specialties / Areas of Professional Practice Please list areas of practice, one per line About Your Practice * Write as much as you would like for the public to know about you and your practice. To effectively optimise your page for Google we need about 500 words I only use hypnosis for therapeutic purposes * Yes No I have read and agree to all of the conditions of listing on the HCA National Register * I agree reCAPTCHA Submit Δ
