FENG SHUI INSTITUTE OF MINNESOTA by sir68701

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									                                    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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