International Directory of Energy Medicine Professionals

To apply for a listing in ITEM’s International Directory of Energy Medicine Professionals, please complete the form below and press the submit button.  We will not share this information with outside parties.  ITEM will contact you by email within two weeks to inform you of our decision.  The annual listing fee is only $19.95.  If you are accepted, ITEM will provide you with the website to make payment using your credit card, or you can mail a check, money order or bank draft.  Fields in bold are required (if a required field does not apply to you, simply write “none” or “0” in the space).

Contact Information
First Name:   Last:
Street Address:
City:  State/Province:
Zip/Postal Code: Country:
Home Phone:-   Work:-
FAX:-
E-Mail Address:
Company:
Website:
Education
1.  Degree Held:  Year Completed: 
University/Institution:
Major/Area of Study:
2.  Degree Held:  Year Completed: 
University/Institution:
Major/Area of Study:
Work Experience Summary (List Current Position First)
1. Position/Job Title:    From (Year):  To:
Employer/Company: Street Address:
City: State/Province: Zip: Country:
Job Description/Duties:
2. Position/Job Title:    From (Year): To (Year):
Employer/Company: Street Address:
City: State/Province: Zip: Country:
Job Description/Duties:
3. Position/Job Title:    From (Year): To (Year):
Employer/Company: Street Address:
City: State/Province: Zip: Country:
Job Description/Duties:
Additional Information
References
1. Reference First Name:    Last Name:
Employer/Company: Street Address:
City: State/Province: Zip: Country:
Relationship:  E-Mail Address:
2. Reference First Name:    Last Name:
Employer/Company: Street Address:
City: State/Province: Zip: Country:
Relationship:  E-Mail Address:

Other Information


 

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