Form for Accreditation of Wellness Profession Name Last Name Full Address Country Date of Birth Gender Female Male Phone Number Primary Contact Email Choose: 1 Level: Junior Wellness Practitioner 2 Level: Wellness Practitioner 3 Level: Wellness Holistic Wellness Specialist 4 Level: Wellness Ambassador Your Website Your Social Media Short description of Your Work and Yourself How many months or years are you working in the Wellness Industry? Your C.V. Your Pro bono, charity or volunteer work in the Wellness field (Ambassador only) Copy of your Offical Diploma Qualifications (Bachelor, Masters..ect) Copy of your unofficial Qualifications (Certificates, Diplomas..ect) A picture of you (for the Directory) Assignement: What is your Higher Goal in Wellness for a) Your Clients and b) Yourself and c) Your Family? (Ambassador only) Are you Insured? Yes No Have you had any sanctions passed against you by another regulation awarding body or accreditation board? Yes No Comments or Questions Send
