Hardship Membership Form | IBA Japan Members

Thank you for your interest in becoming a Member or continuing your Membership with the International BodyTalk Association (IBA) family. Your request is important to us, as we are committed to supporting individuals who wish to be a Member of our Association but are experiencing current financial hardship. We extend scholarships for a period of one year to those individuals who can establish financial hardship. Submitting an application does not guarantee a scholarship; however, our review committee will assess your income eligibility needs and offer you a prompt reply. Please allow us a full week to get back to you before contacting our office for decision responses. Thank you.

Hardship Application

Last/First Name

Name in Kanji

Birthday

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

Part 2

I would like a:

General Membership $130 USD

Practitioner Membership $250 USD

Is this a new membership?

Yes

Are you a current IBA Member?

Yes

If this is not a new membership, please indicate why your membership lapsed.

Part 3 Please describe your special needs and determining factors that you feel should be considered in evaluating your financial hardship status (for example, medical/hospital expenses, lack of employment, family death, or other catastrophic event).

Please describe why you need a hardship grant.

Part 4 Statement of Understanding and Acknowledgement

By signing this application,

I certify that I am requesting a hardship scholarship from the IBA for a one year renewal term based on financial hardship needs stated above, and
I understand that I may be requested to provide addition information to document my hardship needs which may include proof of income or tax filings, and
I certify that the statements relating to this application are complete and correct to the best of my ability and intentional misrepresentation in this application may result in cancellation any scholarships awarded and/or may result in adverse consequences to my membership and related benefits.
I further understand that if I am granted a scholarship that the scholarship is not transferable, or redeemable for any monetary consideration.

Applicant's Signature

Thank you for your application! The IBA will respond to you within 10 business days to let you know if your scholarship has been approved.

Hardship Application

Part 2

Part 3

Please describe your special needs and determining factors that you feel should be considered in evaluating your financial hardship status (for example, medical/hospital expenses, lack of employment, family death, or other catastrophic event).

Part 4

Statement of Understanding and Acknowledgement By signing this application,

Statement of Understanding and Acknowledgement

By signing this application,