apply test - Buteyko Breathing Educators Association

Personal and Contact Information

Title

First Name(s)*

Last Name*

Business Name

Business Address Line 1*

Business Address Line 2

City*

State/Prov*

Zip/Postal Code*

Country*

Mailing Address*

Mailing Address

City*

State/Prov*

Zip/Postal Code*

Country*

Business Phone*

Business Email*

Personal Phone*

Personal Email*

Preferred email communication*

Business email
Personal email

Skype ID

Primary Website

Other Website(s)

Current Occupation*

Occupation since (yyyy)*

Languages you are fluent in*

Foreign language fluency is requested for referrals needing specific language proficiency. If you are able to teach in a language, that counts as fluent

Advanced Education, Professional Certifications

If you have no post secondary education and go to next Section. Post-Secondary Education: (list all degrees). Please attach copies of degrees.

DegreeMajorInstitutionGrad YearUpload

Degree 1

Major 1

Institution 1

Grad Year 1

Upload 1

Max. file size: 256 MB.

Degree 2

Major 2

Institution 2

Grad Year 2

Upload 2

Max. file size: 256 MB.

Degree 3

Major 3

Institution 3

Grad Year 3

Upload 3

Max. file size: 256 MB.

Degree 4

Major 4

Institution 4

Grad Year

Upload 4

Max. file size: 256 MB.

* Enter the acronym for your degree. If there is none, leave blank (BA, MS etc.)

Initial Buteyko Training (to become an Educator)

At least 1 training required except for public members*

Trainer NameLocationDate(s)Upload

Trainer Name 1

Location

Date(s)

Upload 5

Max. file size: 256 MB.

Trainer Name

Location 2

Date(s) 2

Upload 6

Max. file size: 256 MB.

Trainer Name 3

Location 3

Date(s) 3

Upload 7

Max. file size: 256 MB.

General Recommendations

CPR training*

Yes
No

I Have Professional indemnity Insurance*

Yes
No

BBEA members can purchase insurance in the USA from Associated Bodywork and Massage Professionals at www.abmp.com

Please view the following code of ethics

You are certifying that you have read and understand the BBEA code of ethics and agree to abide by them*

I Agree

You are certifying that all information recorded on this application and any attached documents, or documents you send are accurate and support your qualifications for BBEA membership*

I Agree

You are certifying that you have read the liability statement below and agree*

I agree

Liability Statement

Each person who is or was a member of The Buteyko Breathing Educators Association, shall accept personal responsibility, and assume liability, for any and all actions, manners, and conducts made outside the scope of The Buteyko Educators Association’s Code of Ethics. The member shall indemnify and hold harmless The Buteyko Breathing Educators Association, and all of its trustees, adm inistrators, beneficiaries, shareholders, partners, members, managers, owners, agents, employees, officers, directors, heirs, personal representatives, successors and assigns, from and against any and all claims, damages, costs, liabilities, judgments, awa rds, losses and expenses, of whatever kind or nature, at law or in equity, arising out of any and all acts of the member that are in violation of or outside the scope of The Buteyko Breathing Educators Association’s Code of Ethics. Amounts paid in indemnif ication of expenses and liabilities may include, but shall not be limited to, counsel fees, other fees, disbursements costs, judgments, fines, penalties against and amounts paid in settlement by and for such member.

Signature*