Member (ASPEUS) Data Form - New
Everyone who has attended AT LEAST one Sansthan training MUST fill this form. You will need scans of your latest photo (< 200 kb), highest educational certificate (< 300 kb), and acupressure certificate from the Sansthan (<300 kb). Your photo will be used for your membership card, use a light background for clarity.
Title
You can choose to be either female or male or a doctor
First Name *
Write only your first name here
Your answer
Middle Name
Provide your middle name(s) here, this is optional
Your answer
Last Name (Surname) *
Write only your last name here
Your answer
Father's / Mother's Name *
Write your father's or mother's name as in first, middle, last (surname).
Your answer
Age as on 7 December 2016 (in years) *
Write a number without any additional text. For example, if you are 51 years old, simply write 51
Your answer
Last Educational Qualification *
Associated with ASPEUS since *
Write the year with which you came into contact with ASPEUS
Your answer
Acupressure Qualification *
Check all that apply to you
Required
Average number of cases / day *
Write a number. If you see 35 patients in a week, this is 5 patients per day. So simply write 5. This is your AVERAGE daily number. This is for you personally, please encourage all your centre's therapists to fill their own forms with their own case load.
Your answer
Other skills besides Acupressure
Write skills separated by a comma, such as management, training, technology, distance healing, reiki, yoga, etc. Mention specific skills here as in the example. If none, enter None.
Your answer
Contact number - 1 *
Enter only 1 number here - your preferred contact number. Do not leave spaces between the numbers. Example, 1234567890
Your answer
Contact number - 2
Enter only 1 number here - your preferred contact number. Do not leave spaces between the numbers. Example, 1234567890
Your answer
Email id *
Your answer
PIN Code *
Write your PIN Code without any spaces, example, 211001
Your answer
State *
City *
Write only the city name, without any other information, example, New Delhi
Your answer
Complete Address *
Write your full address, (WITHOUT City, State, PIN code, as these are written above)
Your answer
Upload recent picture *
Click https://goo.gl/xApG6H to upload your photo. Max size is 200 kb. This will open in a new tab. Close the tab after you have received your file id number. Enter the ID number below.
Your answer
Upload highest educational qualification *
Click https://goo.gl/IzuBSi to upload your educational certificate. Max size is 300 kb. This will open in a new tab. Close the tab after you have received your file id number. Enter the ID number below.
Your answer
Upload any one acupressure certificate from ASPEUS
Click https://goo.gl/IzuBSi to upload your acupressure certificate. Max size is 300 kb. This will open in a new tab. Close the tab after you have received your file id number. Enter the ID number below.
Your answer
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