International Council of Electro Homeopathy

P.O.Box 66005, Stockton, CA 95206, U.S.A.
Ph.209-271-2337,209-464-3884, Fax.209-943-2838
                   

 REGISTRATION FORM
                  
Name ____________________________________________D.O.B._____________Age___________
Address________________________________________Phone__________________________
City__________________State_______________Zip______________County______________
Licenses, if any________________________________________________________________________
Years of Electro Homeopathic Education____________Practice__________________Country___________
Schools where education in Electro Homeopathy was received:
A.______________________________________Location______________________________
Degree or Diploma Earned_________________________________________Year________________
B.______________________________________Location_______________________________
Degree or Diploma Earned_________________________________________Year________________
Application is made for Membership/Renewals/Lifetime/Fellowship____________________________
I hereby certify that the answers are correct, and that I am not in any way trying to entrap the International

Council of Electrohomeopathy.


Signature_________________________________________________Date_________________


The following should be attached to the Registration Form:
Appropriate Fee, Copies of all testimonials, Recent Photograph of yourself, CV of yourself.
Application fee $50/-, Membership fee $ 175/- Renewals $ 50/-,Lifetime fee $ 500/-,
Fellowship fee $ 500/-

SECTION 2

PAYMENT DETAILS
Registration form, completed in all respect along with the registration fee, may be sent to the ICEH secretariat by any of the options below,
1. You can transfer the amount by Wire/Swift transfer in the following Bank account:
• Bank Name: Bank of America
• Accounts name: ANMA
• Account No: 11394-44401
2.Payment could also be made by DD/ Multi-city Cheques/Bank transfer to your nearest ICEH  authorised Center. 

A list of authorised centers may be obtained upon request