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Visceral Manipulation Certification Application Form

Visceral Manipulation Certification through the Barral Institute is much more than a credential. The VM Certification credential establishes you as a dedicated professional with the knowledge and skills to uphold high standards of excellence. VM Certification increases your networking and referral status, as your colleagues and potential clients see your commitment to excellence.

Todays Date *

First Name *

Last Name *

IAHP Student ID

Your student number appears on your Certificate of Attendance. If you are unable to locate your student ID please contact Shane Hill.

Professional Title *

Address

City

State/Province

Zip/Postal

Country

Work Phone *

Home Phone

Mobile Phone *

Email *

Education

Education (include basic post-high school preparation through highest degree held): *

Institution (Name, state) - Degree, Diploma, Certificate - Year Awarded

Professional Qualification *

Issued By *

Number *

Date issued *

Expiration *

Professional Qualification

Issued By

Number

Date Issued

Expiration

Professional Qualification

Issued By

Number

Date Issued

Expiration

Year Practice Began *

Professional Association *

I have completed the pre-requisites and am applying and registering for: *

Techniques Certification Level - CVTP

Practitioner Certification Level - CVMP

I understand that a Visceral Manipulation Certification through the Barral Institute certifies a person’s abilities in Visceral Manipulation (VM). Since certification does not provide a legal right to practice, a person must have the appropriate credential and/or license to practice manual therapy in their locale. *

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Visceral Manipulation Certification Application Form

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