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Affiliate Registration form   
This form is now closed: Here is the link to our 2026 Affiliate sheet


Email *
WELCOME TO OUR WORLD!
Owner Name and Surname: *
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Business Name: *
If none just state Hybrid Academy ( Centre owner OR Therapists OR Tutors OR Suppliers OR Intern.)

Hybrid Affiliate Virtual / Provincial
Hybrid City Supplier
Hybrid Centre
Hybrid Tutor
Hybrid Therapist
Hybrid Intern
Contact number  *
Your cel phone number.
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Your Address: *
*These details are shared with parents when they register their child. 
Your Province:   *
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Your City/Town  *
Example:
1. City - Cape Town
2. Area you service - Bloubergstrand, Melkbos, Parklands.
*Add area's closest to where you are at for example: 

*These details are shared with parents when they register their child. 
Copy paste your location using google maps: *
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Your Website link or Facebook profile link  - if any.
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Friendly looking Head and Shoulders picture of yourself with a dark or light background. *
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Add file
Required
Highest Qualification Obtained: *
If you run a learning centre ensure you display your Bed degree and first aid certificate.
All therapist - ensure you are registered with ASCHP as Specialist Wellness Counselor and share both your certificates in your consent form.
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