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Membership Form

Please have the following information available:

Student applications: Student ID or Enrollment Confirmation from your current school. AHC or AP applications: copy of certification from your Ayurveda school(s) Credit Card for membership payment

I am applying for a Professional Membership as: *

Ayurveda Health Counselor (AHC)
Ayurveda Practitioner (AP)
Student

Prefix *

Vaidya
Miss
Mr.
Mrs.
Ms.
Prefer not to state

Name *

First

Last

Designated Title Provided by Educational Institution: *

BAMS
CAS
AC
AWC
AP
Other

If you selected "Other," please provide details:

Address *

City *

State *

Country *

Zip / Postal Code *

Contact Number (Just enter digits without +/-) *

Email *

Business Name (If Applicable) *

School(s) Attended:

If applying for the Ayurveda Practitioner(AP) level membership, provide the name of the school that certified you at the AP level. If applying for the Student level membership, provide the name of the school where you are currently studying. If your school is not a CAAM Educational Institution Member (see CAAM directory, or contact your school to confirm), then you need to provide the name of the school(s) that certified you at the Practitioner and Counselor levels.

Name of Educational Institution: *

Address: *

Phone: *

Contact Email *

Program Title/Name: *

Level for which the program qualified you to apply for: *

Do you have more than 3 schools to report? *

Yes
No

If yes, the Membership Committee will be in-touch to get the additional information from you

Graduation date: *

Month/Year

Additional Information

Additional Certifications or Licenses:

Aromatherapy
Chiropractic
Herbalism
Homeopathy
Jyotish
Marma
Massage
M.D.
Meditation
MFT
Naturopathy ND
Panchakarma Therapist
Psychologist
TCM
Vastu
Yoga
Other

Please choose all that apply:

If you selected "Other," please provide details:

Have you ever been convicted of a felony or a crime involving dishonesty or moral turpitude *

Yes
No

If Yes, provide details (if No, type N/A) *

Have you ever had any license to render healthcare services or any other professional services suspended, revoked or limited in any state or jurisdiction or been reprimanded, sanctioned or disciplined by any licensing board *

Yes
No

If Yes, provide details (if No, type N/A) *

Please attach Student ID or School Enrollment Confirmation or Certificates / Degrees *

Click or drag files to this area to upload. You can upload up to 5 files.

Please upload a passport size photo for your CAAM Membership Card

Click or drag files to this area to upload. You can upload up to 5 files.

Disclaimers

CAAM does not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

I have reviewed CAAM’s current requirements for the membership category for which I am applying and certify that I meet all of these requirements;

I will provide CAAM such other information and materials as CAAM may request at any time and from time to time, for the purpose of determining if I comply with the requirements and other standards in effect now or in the future for membership in CAAM;

I shall act in a manner in compliance with all CAAM policies and requirements, and all applicable federal, state and local laws, and shall be careful to avoid any act or conduct which might injure, directly or indirectly, in any manner, the reputation of CAAM or any other person or entity associated with CAAM;

Approval of this application is within CAAM’s sole and absolute discretion;

My membership in CAAM, if approved, shall be for a one-year period, unless terminated earlier pursuant to CAAM’s rules, regulations, or other standards then in effect;

Should my membership in CAAM lapse or terminate for any reason, I understand that if I wish to renew my membership, I will be required to submit a new application and comply with CAAM’s membership requirements and other standards then in effect;

I hereby authorize CAAM, in its sole discretion, to perform and/or request criminal history checks and other background investigations to verify any and all information provided in connection with this application, and understand that discovery of false information in or related to this application, or of relevant criminal history, may result in denial or termination of this application, and/or my membership in CAAM;

All statements, answers, and representations made in this application and/or in any supplementary materials are true, accurate, and complete.

I have read the CAAM Membership Agreement and agree to all terms

Date *

Signature (By entering my name below, I’m acknowledging the use of my digital signature to confirm the above terms) *

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