Registration Details

Please tick the appropriate box

Student*

Fee – Initial $125.00 – Annual renewal $115.00

I’m applying for the following registration level

Certificated Kinesiologist*

Fee- Initial $180.00 | Annual renewal $135.00

Certificate in Kinesiology or equivalent 1 years training – 300 Hours

Registered Kinesiologist*

Fee – Initial $250.00 Annual renewal $180.00 (Includes NHC Affiliation Fee)

Diploma of Kinesiology or equivalent 3 years training – 500 Hours

Registered Kinesiologist Senior Consultant*

Fee- Initial $250.00 Annual renewal $180.00 (Includes NHC Affiliation Fee)

Advanced Diploma of Kinesiology or equivalent 4 years training – 650 Hours

Title*

Name*

Clinic Name*

Clinic Address

Street Address Address Line 2 City ZIP Code

Postal Address

(if same as Main Clinic Address, please leave blank)

Street Address Address Line 2 City ZIP Code

Phone

Mobile

Your Kinesiology qualifications

Diploma in Kinesiology

Yes

Copy attached – Yes

Certificate in Kinesiology

Yes

Copy attached – Yes

Other accredited Kinesiology course qualifications

Yes

Copy attached – Yes

Kinesiology Course Training for Recognition – other accredited course qualifications

The following are the workshops and training hours I have completed in Kinesiology and Associated Health courses: Relevant Certificates of Competency for Kinesiology and Associated Health courses are attached and academic transcripts and evidence of hours studied are also attached for Anatomy and Physiology; Nutrition; Practice/Business Management (if applicable).

Name of Core Kinesiology Courses*

Instructor/College*

Date obtained Hours*

Name of Core Kinesiology Courses

Instructor/College

Date obtained Hours

First Aid

Please attach a copy of your current First Aid Certificate. My certificate is attached:*

Yes

Payment

I have arranged payment of my membership and admin fees:

Yes

Amount

Payment method: Electronic transfer – ASB 12-3027-0442945-00, please attach your remittance receipt / Date payment made:

Payment method:

Cheque

Money Order

Professionalism

Have you ever been convicted of a criminal offence?

Yes

Been investigated for alleged professional misconduct or?

Yes

Have you been refused membership of any professional membership body?

Yes

If you must answer “Yes” to any of the above, please provide details to accompany your application.

I consent to my name being forwarded to the Natural Health Council and Natural Health Practitioners NZ

Yes

I would like my name to appear on my annual practicing certificate as:

DECLARATION

I, hereby confirm that the details included in this application form and my supporting documents to be true and correct. As a practitioner registered with the Kinesiology Practitioner Accreditation Board (“KPAB”) I agree to abide by the Constitution and By-Laws. As a practitioner registered with KPAB (at any level), I shall at all times abide by The Institute Code of Ethics and Conduct and maintain a current First Aid Certificate Continuing Professional Education (CPE) has become a necessary part of a professional’s life. The purpose of CPE is to ensure Professional Practitioners regularly update their clinical skills and professional knowledge. It is a commitment to updating and furthering one’s education.

attended 15 hour kinesiology-related workshop (or 2 x 8 hour workshops)
OR present a 30 min kinesiology paper at a conference or recognised research workshop
OR have a kinesiology article published in a journal

CODE OF ETHICS AND CONDUCT

Principles of ethical behaviour applicable to all kinesiologist, including those who may not be engaged directly in clinical practice.

Consider the health and well-being of your client to be your first priority.
Strive to improve your knowledge and skill so that the best possible service can be afforded to your client.
Honour your profession and its traditions.
Recognise both your own limitations and the special skills of others in the prevention and management of “dis-ease”.
Protect the client’s confidences even after his or her death
Let integrity and professional ability be your chief advertisement.

I have read and understood and agree to comply with the above at all times during my membership with KPAB. I also understand that a membership year starts in January and finishes in December, KPAB reviews memberships annually.

Full Name

Date

Test Form

KPAB New Registration Application Form

Registration Details

I’m applying for the following registration level

Your Kinesiology qualifications

Kinesiology Course Training for Recognition – other accredited course qualifications

First Aid

Payment

Professionalism

If you must answer “Yes” to any of the above, please provide details to accompany your application.

DECLARATION

CODE OF ETHICS AND CONDUCT

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