Name:______________________________________ Birth Date:_______________________

Job Title: ________________________________

Business Name:_____________________________

Address:_____________________________________________________________________________

Telephone:_________________________________E-mail:___________________________________

Fax: __________________________________

Website Address: ____________________________________________________________

Highest Degree (give initials):________ Date of Degree:___________________

University or College:_________________________________________________________

Applicant's Signature:_______________________________ Date:____________________

List Two References: 1)________________________________________________________ __________________________________________________________________________________

2)_____________________________________________________________________________
______________________________________________________________________________

If you are or wish to becoming a Consultant in Good Standing, please (1) tell us which version of the HVP you will be using:_______________________________________________;
(2) please tell us if you will be paying your own royalties on the HVP, or else give us the name and e-mail address of your Distributor for the Hartman Value Profile ____________________________________________________________________________________; and
(3) please describe the training you have had in using and interpreting the HVP
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

The current dues schedule for the calendar year is:
Regular members: $50.00
>Student and Retiree members: $10.00

Please send your application and a check made out to the R. S. Hartman Institute to:
Dr. Rem B. Edwards
Secretary/Treasurer, R. S. Hartman Institute
8709 Longmeade Drive
Knoxville, TN 37923 USA