Membership Maintenance Form – Malaysia Integrative Hypnotherapist Association

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Membership Maintenance

Apply the membership with us to enjoy the benefits and maintain your professional standards!

"*" indicates required fields

Type of Maintenance

Type of Maintenance*

Select Type of Membership For Renewal / Upgrade / Downgrade

Student Member

Associate Member

Corporate Member

Social Welfare Member

Volunteer Member

Reason of Membership Cancellation

Personal Information

Full Name per IC*

- Membership ID*

Phone Number*

Email*

Qualification Information

Kindly select your modality in mental health industry.

Select one or more

Hypnotherapy

Psychotherapy

Counselling

Psychology

Art Therapy

Child Therapy

Speech Therapy

Cognitive Behavioural Therapy

Other

Other Modality

Hypnotherapy / Psychotherapy Qualification Studies

Click + to add more

Date of Graduation (dd/mm/yyyy)

Name of Institution / Academy

Name of Program / Course

National / International Accreditation Body

Click + to add more

Date of Accreditation (dd/mm/yyyy)

Name of Accreditation Body / Association

Name of Professional Title

Academic Qualification

Click + to add more

Year of Graduation

Name of College / University

Major Studies

Other Professional Program Attended (If Any)

Click + to add more

Course Name

Duration

Name of Institution / Academy

Profession

Document Checklist

Kindly upload your documents for verification purpose.

Highest Education Qualification and Certification

SPM, Diploma, Degree, Master or Phd

Drop files here or

Max. file size: 64 MB.

Letter of Admission / Offer Letter

Drop files here or

Max. file size: 64 MB.

National or International Certificate in field of Mental Health

Hypnotherapy, Psychotherapy, Psychology or other relevant certification

Drop files here or

Max. file size: 64 MB.

Company SSM Superform

Drop files here or

Max. file size: 64 MB.

Once your membership maintenance is approved, you will be guided to make payment via email instruction.

Membership Agreement

Agreement*

- I hereby confirmed and agreed that all information that I provided are absolutely accurate and correct.
- As being a MIHA members, I also agreed to comply with included but not limited to MIHA's Code of Ethic, Code of Discipline, Guidelines, Policies and Membership Handbook.

Yes, I Agree.

Signature*

Full Name per IC*

IC No.*

Date of Submission

Email

This field is for validation purposes and should be left unchanged.

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Block Member?

Please confirm you want to block this member.

You will no longer be able to:

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Mention this member in posts
Invite this member to groups
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