New Therapist Registration Form Massage Therapist Registration Form Therapist Name * First Last * Last Therapist Email * Therapist Phone * Therapist Address Therapist Address Street Street Therapist Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Therapist Address What Modalities Do You Offer? * Swedish Massage Deep-Tissue Massage Thai Massage Myofascial Techniques Energy Work Cranial Sacral Massage Lymphatic Massage Sports Massage Infant/Elderly Massage Other Not ListedOther Not Listed Do you offer the following Services? * None Aromatherapy CBD &/or Other Oils Cupping Scraping TheraGun Hot/Cold Treatments Other Add-On's Not ListedOther Add-On's Not Listed Upload Your Resume Drop a file here or click to upload Choose File Maximum file size: 516MB Please Read By filling out and signing this form, you agree to our <a href="https://auraom.com/privacy-policy/">terms and conditions</a>. <span style="color: #ff0000;"><strong>You also understand that We/ AuraOm Therapy and Massage, does NOT GUARANTEE EMPLOYMENT, or compensation, at all whatsoever. </strong></span>Although "We", our board of directors and affiliates make every effort to promote and advertise the services and modalities offered online and in person, the unique opportunity we offer is to help promote, educate, and employ therapists to the best of our ability. That being said, You also agree to split the commissions and/or earnings you receive up to 40% with AuraOm Therapy and Massage, for the following, but not limited to; Marketing, advertising, promotions, print ads, local ads, sponsorships, and the like. As a Co-Op partner, you agree to have your likeness, images, schedule, services, and all relevant information available for public display, on the AuraOm Therapy and Massage website, promotional materials, social media, etc. You also agree to be filmed and recorded and photographed. Lastly you agree to hold harmless any and all members of AuraOm Therapy and Massage, its direct members, board members and affiliates. Feedback or Suggestions (Please write Below) * Therapist Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
