FENG SHUI INSTITUTE OF THE MIDWEST PRACTITIONER MEMBERSHIP APPLICATION FSIM is committed to promoting high standards in the practice of Feng Shui through continued growth in education, innovation, and support for the membership and the community at large. www.fsim.org Name ________________________________________________________________________ Feng Shui Business Name _________________________________________________________ Feng Shui Business Address _______________________________________________________ street _______________________________________________________ city state zip code Feng Shui Business Telephone (____)________________ Fax Number (___)_________________ E-mail Address ________________________________ Website _________________________ Membership Classification ________________ Payment Date __________ Check # _______ Practitioner $99 per year - Please provide detailed information about your practitioner training below Friend $54 per year Student $36 per year – Please provide information regarding your studies below Name of Teacher ________________________________ Number of Hours ____________ Name of Teacher ________________________________ Number of Hours ____________ Name of Teacher ________________________________ Number of Hours ____________ Are you currently consulting? _____ How many hours per month? _____ Are you currently teaching? _____ How many hours per year? _____ Would you be interested in serving on FSIM committees or working on special projects? ____________ In what capacity? __________________________________________________________ Signature ___________________________________ Date _______________ Please return completed form to: FSIM c/o Cathy Galvin 8 Bishop Lucker Lane New Ulm Mn 56073 Thank you for your interest in FSIM. Note for Practitioners: Your application may be reviewed by the Credentials Committee and, if necessary, an interview with representatives of the Institute will be scheduled as quickly as possible.
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