1. I, the undersigned, do hereby make voluntary application to the Biofeedback Certification International Alliance – formerly the Biofeedback Certification Institute of America (BCIA). I certify that the information given by way of this application is true, honest, and completely represents me.
2. I will conform to all applicable local, state, and federal regulations and conduct myself consistent with the highest standards relating to my profession and specialty.
3. I have received, read and agree to be bound by the BCIA Professional Standards and Ethical Principles of Biofeedback (PSEP) and their policies and procedures. I understand that the PSEP and any BCIA policies and procedures may be amended from time to time and that I am bound by these documents as amended. I also understand that in accordance with such policies and procedures:
(a) the final determination of any dispute arising between me and BCIA will be made by its board of directors and that I will be bound by the board’s determination and may not seek review;
(b) however, if grounds exist that would permit a court to overturn or modify the board’s determination or otherwise act in the matter, that I will seek redress only in Denver, CO and only by arbitration in accordance with such policies and procedures; and
(c) because I have agreed that the board’s determination is final and binding upon me, I am likely to be required to pay the costs, reasonable attorney fees and other expenses of BCIA in any proceedings instituted by me.
4. I understand and agree that BCIA and its affiliates assume no responsibility for my actions or activities. I practice at my own risk and hereby release BCIA from any and all liability from any practice decisions I make.
5. I hereby give permission to BCIA to contact individuals or agencies listed for verification of information submitted. I recognize that failure to do so may result in disciplinary action including suspension or revocation of my certification.
BCIA reserves the right not to accept your application based on any information submitted. To be considered, applications must include signature and filing fee.
Filing fee: $25 for BCIA certificants or students pursuing a BCIA approved health care degree from a regionally accredited academic institution or $50 for all other interested professionals.