CSCH Membership Application

Membership Type

Please indicate the membership level for which you are applying.

Personal Information


Your most advanced clinical degree (from an accredited university) and field in which it was granted:


Your current license number, expiration date, and online location where it can be confirmed (Dora, etc.)


Were you referred by a current CSCH member?

Additional Material

• Certificates of completion for any hypnosis training you have taken (one 20 hour ASCH‐approved course required for Full membership), or proof of ASCH membership. • Include a short statement on your interest in hypnosis.