RCST Member Renewal Renewal Fee is $140.00 USD Please note that membership payments are not eligible for refunds. Thank you. For a printable PDF form, please click the button below: RCST Member Renewal Form Please fill out the form below: Contact information (for use by the organization) 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 (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) Credentials (required)(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 RCST Self-Awareness/Self-Care Record June 1, - May 31, Record of Self-Awareness/ Self-Care Sessions (Please include type of session, location, and date) The BCTA/NA values self-awareness and self-care in relationship to professional therapeutic practices. Yearly, the records of, but not limited to, four (4) sessions are required 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. Session 1 Session 2 Session 3 Session 4 All Applicants 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 I hereby agree and undertake to follow the Standards of Practice and the Code of Ethics of 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 Comments Logo Use I have read the full text of the Logo Use Agreement (viewable here) and agree to abide by its terms for use including: (Please remember that the Biodynamic Craniosacral Therapy Association of North America (BCTA/NA) is the sole owner of these logos.) Only BCTA/NA Members can use the BCTA/NA logos. Displaying the BCTA/NA logo requires compliance with all conditions required in its use. BCTA/NA logos must not be revised or altered in any way, and must be displayed in the same form as produced by BCTA/NA. The logos may be used in a professional manner on the user’s website, business cards, stationery literature, advertisements, presentations, storefront window, or in any other comparable manner to signify the user’s BCTA/NA membership. Logos may not be used in any manner that discredits BCTA/NA, is false or misleading; violates the rights of others, any law, regulation, or other public policy; or mischaracterized the relationship between BCTA/NA and the user. Upon termination or expiration of your membership you will immediately discontinue use of any and all materials that display this logo. I understand that entering my initials here is my electronic signature: 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 via secured online payment, you will be immediately sent an email with the payment link attached. If you are paying via check by mail (U.S. banks only please), 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.