Connecting People On Their Spiritual Path Membership Registration Form Date* Date Format: DD slash MM slash YYYY Member InformationName* First Last Address* Address line 1 Address line 2 Town/suburb Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Phone*Email* IPMI Membership DetailsMembership Level Options*Select a 1 year membership to IPMI-Australia.Subcriber MembershipCommunity Service MembershipUsername* This will be used to login to your membership level area.Password* Enter Password Confirm Password Remember this password you will be using it to login to your Membership Account Area. If you lose the password you can reset using the email provided above.Additional Member InformationHave you experienced the 1001 Profile?*YesNoAre you a Contracted Instructor with the Wayshowers College?YesNoDate Signed as a Contracted Instructor.Who did your 1001 Profile?Approximate Date of your 1001 Profile Date Format: DD dash MM dash YYYY Let us know your first and second giftExample - Vision FeelingFor Platinum Membership, please list date of the following profiles: 1001s, 1002a, 1003a, and 7004Example, 1002a March 2009; 1001s April 2009, 1003a May 2010, 7004 June 2010. All profiles are a prerequisite for Platinum Membership.Membership Total $ 0.00 CAPTCHA