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The practice of hypnotherapy is self-regulated in Kentucky rather than being government regulated, and we trust it will always be so.  In order to protect the public and the profession from untrained and unscrupulous practitioners, KAH has established basic requirements for training and ethics.  KAH will accept membership from only those applicants who meet the following training requirements: 

1. A minimum of 100 contact hours of instruction, by a qualified hypnotherapist in the following subjects:

   a. History and nature of hypnosis
   b. Interviewing and assessment of the client
   c. Law and ethics
   d. Induction and dehypnotization (emergence) techniques
   e. Principles of post-hypnotic suggestion
   f. Habit control, including weight control and smoking
   g. Deepening the hypnosis
   h. Preparation of suggestions
   i. Reframing to remove cause
   j. Personal development
   k. Self-hypnosis 

2. Documentation of twenty-five (25) sessions of hypnotherapy conducted under the supervision of a qualified hypnotherapist or documented experiences or sessions. 

3. Two letters of recommendation concerning the good character of the applicant

4. Statement that applicant has never been convicted of a felony or lost a license to practice a profession in any state.

5.  Copy of drivers license or ID.

A member may be decertified by KAH for violation of the Code of Ethics.

Procedure for applying for membership:  
An Applicant becomes an associate member first for $25.00 and then applies for full membership which is granted after review of the 25 submitted hypnotherapy sessions.  The additional fee for certification is $15.00.  Please fill out application and send to
Registrar, Allen Mills,
safetyd@windstream.net
                                                         KAH Application Form

Section 1

Membership status
Choose the membership for which you are applying
Associate   Full hypnotherapist    Renewal of lapsed membership 
  
If  applying for full hypnotherapist or are lapsed and renewing,
please complete Sections 5 and 6 as well.

Section 2

Person information

Last name:                      First Name:

Street:                                   City:                      State and zip

Email:                               Website(if applicable)

Phone:                             Fax:

Date of birth:


Section 3

Qualifications and education
I am already certified____
Please list certifying:  Organization or school__________________
                                   Instructor____________________
                                   Total Training hours________
I've practiced hypnotism since_________________
List any other hypnotism related memberships or training___________________________
________________________________________________________________________
Highest level of education attained._________
Have you ever been convicted of a felony?
If yes, please explain on a separate sheet.
Have you ever been dismissed from any professional organization because of an ethics complaint?__
If yes, please explain on a separate sheet.
Your current occupation

Section 4

KAH requires an official photo ID(color copy-driver's license/passport) in order to process the application.  It is agreed and understood that, if at any time, the KAH becomes aware of any false or misleading statements in this application, it has the right to immediately revoke membership privileges.  By submitted this application, you agree that all information provided is true, correct, and complete.  The KAH has your permission to verify the information reported by obtaining documentation as needed.

Electronic submission is your E-signature.  You may be asked to sign the form at a later date.

Signature___________                        Date ______________

Section 5

Please complete the section below which applies to your situation.

Seeking membership as a full hypnotherapist  ____

1.  I can provide documentation for 25 sessions of hypnotherapy conducted under the supervision of a qualified hypnotherapist.
2.  If no, how can you document your experience as a hypnotherapist?  Attach information.
3.  Provide certification documents to the KAH.
4.  Provide two letters of recommendation to KAH concerning the good character of the applicant
.

Section 6

Seeking to renew a lapsed membership?
1.  Can you provide doumentation of a minimum of 15 continuing education hours for the past year?
2.  Please provide any other qualifying documents to the KAH.

Foms may be printed and mailed to the KAH registrar:
Allen Mills
8093 Hwy 44E
Mt. Washington, KY 40047
or send to
safetyd@windstream.net