AURA-SOMA PRACTITIONER REGISTRATION AGREEMENT

You may apply for an Aura-Soma Practising Certificate at any time after you have completed Levels 1, 2 and the Personal Presentation Skills Course* of your continuing Aura-Soma colour system training. Once you join the Practitioner System Aura-Soma Education Systems Limited (the Academy) will keep you informed with news and developments concerning the Aura-Soma colour system. By obtaining an Aura-Soma Practising Certificate may a student describe themselves as an Aura-Soma Practitioner and offer Aura-Soma consultations to the public. Please assist us by supplying the following biographic details. *The PPS course is optional if you commenced your training prior to 01.01.2009.

NAME Address

A-S ID #
Please attach a more recent passport type photograph here for your ID card only

Email Tel VAT Reg No: (if applicable) Date of Birth To register for your Aura-Soma Practising Certificate please: Gender Mobile
If any of your details should change please remember to inform Academy staff.

1. Carefully read the practices and conditions set out in the Aura-Soma Practitioner and Colour Care Consultant Guide 2. Carefully read the Statement and Agreement below 3. Complete and sign both pages of this form and return it to the Academy 4. If you have not already done so, please complete and sign the Aura-Soma Student Registration Agreement which includes the data protection statement entitled Important Information, and send it with this Aura-Soma Practitioner Registration Agreement to the Academy. You should have received this at the beginning of your Level 1 and Level 2 course. If not please remind your teacher or contact the Academy for a copy. 5. Select one of the payment options and arrange payment of 25 for 1 year or 50 for 2 years* (plus VAT where applicable) (payment details overleaf) (*Dependant on renewal hours) IMPORTANT INFORMATION From time to time The Academy provides a service of sharing student biographical and training information with overseas representatives of The Academy, Aura-Soma Products Ltd and its network of distributors and, occasionally, with other organisations whose work accords with The Academys objectives. Your details may be used to inform you about events, products and services that may be of interest to you. To opt out of this service please tick this box. PLEASE READ THIS IMPORTANT INFORMATION CAREFULLY BECAUSE IT IS A LEGALLY BINDING CONTRACT BETWEEN YOU AND THE ACADEMY STATEMENT AND AGREEMENT I have read both the Aura-Soma Student Registration Document and the current edition of the Aura-Soma Practitioner and Colour Care Consultant Guide and have had the opportunity to ask my teacher or the Academy questions about them and I confirm and agree that any such questions which I have asked have been satisfactorily answered. The following is not a complete list of my legal obligations to the Academy but it summarises some of the more important ones: I must hold a current Aura-Soma Practising Certificate, pay a renewal fee to renew it every one or two years (dependant on renewal hours) and participate in the Renewal Process if I wish to be an Aura-Soma Practitioner and continue the training to become an Aura-Soma Colour Care Consultant. Give my clients a Consultation Information Sheet at each Consultation to disclose my level of qualification to them. Observe the Consultation Practices and General Practices which are in the Aura-Soma Practitioner and Colour Care Consultant Guide. Observe the restrictions on my right to use the Aura-Soma trademarks, logos, names and products. I have permission, while registered as an Aura-Soma Practitioner, to use the logo shown top left to advertise my consultations according to the rules set out here and in the Aura-Soma Practitioner and Colour Care Consultant Guide. I may only offer printed information to the general public while registered as a Practitioner or Colour Care Consultant. I will only offer printed information that has been supplied or approved by The Academy. Abide by the rules regarding use and recommendation of the Aura-Soma products and my need to avoid making any medical or therapeutic claims for those products. I agree to the Academys right to cancel my Aura-Soma Practising Certificate, terminate my rights and take other action in certain circumstances as specified in the Aura-Soma Practitioner and Colour Care Consultant Guide. Understand my right to appeal against any action taken by the Academy. I agree to practise as an Aura-Soma Practitioner in accordance with all the conditions set out in the Aura-Soma Practitioner and Colour Care Consultant Guide, and everything I have agreed to in the Aura-Soma Student Registration Agreement. I declare that I have not breached the Aura-Soma Student Agreement or any practices or conditions set out in the Aura-Soma Practitioner and Colour Care Consultant Guide.
Signature Date 03/11 A-SPRA1-30

PRACTITIONER REGISTRATION AGREEMENT Page 2

RENEWAL APPLICATIONS ONLY please tick the box if this is a renewal request
Please attach evidence of your participation in the Renewal Process. Course attended: Teacher Name & Date:

Practitioner Register
The Academy also maintains a Practitioner Register. This is available to the public in a printed form and also through the Internet. It is intended to be a resource for the public to find Practitioners for consultations. As a Practitioner you have the right to choose whether to have your name and address and/or telephone/fax/e-mail numbers published. In order to have details made public you must tick the appropriate boxes at the bottom of this form. The Academy will not share any details that have not received a tick.

Skills & Interests and Permission to Share Information

Two further services the Academy offers relate to your skills and interests. By providing a list of their details below the Academy will be able to: 1. Inform you of events and courses that may be of interest to you specifically, and, 2. If you wish, share these details alongside your Register entry so that potential clients or like minded people may identify you.

If we do not have a translation of printed information in your chosen language all correspondence will be made in English.

For each piece of information that you wish to make public you must tick the appropriate box and then sign below.
Name Telephone Address Fax Town or area if whole address is not to be included E-mail Skills and Interests Photograph

I hereby authorise the Academy to share and disclose my personal data (as indicated in the boxes above which I have ticked indicating my approval) to be made public and/or shared by the Academy with others in accordance with all the laws of the UK.
Signature Date

Payment
Select one of the payment options and arrange payment of 25 for 1 year (plus VAT where applicable) 50 for 2 years (Dependant on renewal hours) Bank Transfer: (there is a charge Barclays Bank Plc 65 Lumley Road of 6 for this service) Skegness Lincs PE25 3LU Cheque: made payable to The Academy Sort Code: Account #: SWIFTBIC: IBAN: 20-52-78 90737909 BARC GB22 GB97 BARC 2052 7890 7379 09

Non UK residents Please pay at your own bank, in your local currency at the exchange rate to buy GBP on the day they issue the cheque. Please note that this incurs additional bank charges and therefore you must add 15% of the fee to your payment. Thus 25 becomes 28.75. (plus VAT where applicable) Credit Card: Visa Mastercard AMEX
Expiry Date

Delta

Switch
CNN # Date

Card Number Signature

The Academy, Dev Aura, Little London, Tetford, Nr Horncastle, Lincs. LN9 6QL T: +44 (0)1507 533218 E: enquiries@asiact.org W: www.asiact.org Aura-Soma and the Laurel Leaf logos are registered trade marks and The Academy logo is a trade mark

Please retain a copy of this document for your own records.

03/11 A-SPRA2-30