STUDENT DISCOUNT RCST® APPLICATION Available only to applicants who are currently Student Members and their application is received within 12 months of their foundation training graduation. Fee is $120 USD (($50, one-time application fee + $70 membership fee). If paid between January and May 31 your membership will be paid through May 31 of the following year Please note that membership payments are not eligible for refunds. Thank you. For a printable PDF, please click the button below: Student Discount RCST® Application Form for Mailing To apply online, please fill out the following form: CONTACT INFORMATION FOR USE BY THE ASSOCIATION First Name (required) Last Name (required) Your Email (required) Address (required) Address 2 City (required) State/Province (required) Country (required) Zip/Postal Code (required) Please note the best phone number for internal admin communications. Thank you. Phone Number RCST® FOUNDATION TRAINING INFORMATION Foundation Teacher- if there were co-teachers, please list them all (required) Training Completion Date (required) Graduation Certificate (PDF and DOC files only, Maximum size 2MB) Letter of Recommendation (PDF and DOC files only, Maximum size 2MB) INFORMATION FOR RCST® CERTIFICATE Please give the name to be printed on your RCST® Certificate (required) INFORMATION FOR PRACTITIONER REFERRAL LISTINGS ON THE BCTA/NA WEBSITE (Being listed on the website is the format for the world to verify you are a member in good standing. We would recommend you list on the website. If you do not want to be contacted, please fill out the required boxes only. ) Name (required)(as you would like it to appear on the BCTA/NA website) Do you have any additional credentials you would like to add to your referral listing? (RCST plus 2 additional maximum) City (if you have an office in more than one location, please give both here) (required) State / Province (required) Zip/Postal Code (required) Phone Number(s) Email Website ALL APPLICANTS I hereby agree and undertake to follow the Standards of Practitioner Competencies and the Code of Ethics of the BCTA/NA in the practice of the Biodynamic model of Craniosacral Therapy. I understand the RCST® is the registered trademark of BCTA/NA members in good standing who have been granted RCST® status. The registered trademark symbol ® must always be used with the RCST® designation. I agree to refer to the work as Biodynamic Craniosacral Therapy. YesNo I authorize BCTA/NA to provide all communication for official organizational business to me via email, including the monthly E Newsletter (I authorize paperless communication). YesNo I would like to receive the yearly Cranial Wave Publication in the following format EmailPaper The BCTA/NA values self-awareness and self-care in relationship to professional therapeutic practices. I understand that I am required to submit a Self Awareness/Self -Care Record along with my annual membership renewal form and fee each year by May 31st. This record will include, but is not limited to, four (4) sessions and must meet at least one (1) of the Intentions listed below. In addition to meeting one of the Intentions, each session can be satisfied by one of the Session Options listed below. Self-Awareness/ Self-Care Intentions: · To Support and strengthen the practitioner in developing a presence that is clear, loving, and compassionate. · To Enhance the self-awareness of personal issues that may interfere with holding the field with a client. · To Create a safe environment for personal reflection and professional inquiry. · To Support the practitioner with his/her personal process of inquiry. · To Strengthen the professional’s ability to generate a holding field that creates a healing opportunity for the client. Self-Awareness/Self-Care Session Options: · One (1) hour of Individual consultation with an individual skilled in shadow and reflection work. · One day (7 hours) of continuing education that meets one (1) intention listed above. · Three (3) hours of group discussion (no more than 6 participants) with an individual skilled in shadow and reflection work. If you would like a PDF version of the Self Awareness / Self-Care Record information, click here. Comments PAYMENT OPTIONS Please let us know how you prefer to make your payment. I will make a secure online payment using credit/debit card or eCheck (from a personal account at a U.S. bank)I will be paying via check by mail If you are paying with online Credit/Debit card or U.S. bank E Check, you will be immediately sent an email with the payment link attached. If you are paying via check (U.S. banks only please) by mail, please send to: BCTA/NA 11006 Connally Lane Raleigh, NC 27614 239-206-6078 Send Email By submitting this form, you are agreeing that the information provided is accurate and that BCTA/NA can process your request as if your signature has been provided.