Canadian Shiatsu Society of British Columbia C.S.S.B.C. /カナダBC州指圧協会 Tel & Fax: 604-986-4964  E-mail: info@shiatsupractor.org  Web: www.shiatsupractor.org
Membership Application Form (New application or Renewal)
Membership Status: (Please check "□", the categories which apply to you)
Professional Members	□ Shiatsupractor / SPR		$50.00
	□ Shiatsu Therapist / Supporting   Member		$50.00
Student Members	□ Student / Student Shiatsupractor		$25.00
School Members	□ Authorized Institute		$100.00
	□ Application Fee(New application   only)		$25.00
	□ Donation		$
Total			$
Effective July 1st, 2008 to June 30th, 2009
Member Information: All members please fill out.
(Please check □, if you do not want your information to be on the CSSBC directory on our website.)
□ Name:		□ Home phone #:
□ Home address:		□ Home fax #:
□ Office name:		□ Office phone #:
□ Office address:		□ Office fax #:
□ E-mail & Website address:
Purpose statement (a) To establish and maintain a non-profit organization of the Shiatsu practitioner.  (b) To promote understanding of true Shiatsu therapy which originated with Tokujiro Namikoshi Sensei in Japan for Canadian society.  (c) To promote elevation of the status as the Professional Shiatsu practitioners.  (d) To assist in the improvement of the Shiatsu technique as Shiatsu Practitioners.
I fully understand the definition of Shiatsu and agree to the purpose of the Canadian Shiatsu Society of BC.
Name		Signature	Date
Please make a cheque payable to "Canadian Shiatsu Society of BC" Mailing address: #101 Lonsdale Quay Market 123 Carrie Cates Court, North Vancouver, BC V7M 3K7