Covid Health & Safety Policy
Login
Username
Password
Remember Me
Forgot?
Forget your password?
Username or E-mail
Remembered Password?
About
Breakthroughs International
Brain Gym
Life Enhancement Acupressure Protocols (LEAP)
Contact
Our Team
Admin Team
Board Of Directors
News & Events
BTi Conference 2025
Programs
Brain Gym
®
Developmental Kinesiology
Life Enhancement Acupressure Protocols (LEAP)
Mark Get Set Go
Movement Based Learning
Resources
The Brain Gym
®
Resources
LEAP Resources
General Resources
Donate
About
Breakthroughs International
Brain Gym
Life Enhancement Acupressure Protocols (LEAP)
Contact
Our Team
Admin Team
Board Of Directors
News & Events
BTi Conference 2025
Programs
Brain Gym
®
Developmental Kinesiology
Life Enhancement Acupressure Protocols (LEAP)
Mark Get Set Go
Movement Based Learning
Resources
The Brain Gym
®
Resources
LEAP Resources
General Resources
Donate
Member Registration
Home
/
Member Registration
This field is hidden when viewing the form
User Roles
This field is hidden when viewing the form
Todays Date
MM slash DD slash YYYY
Name
*
First
Last
Email
*
This field is hidden when viewing the form
Contact Email
Phone
Phone
International
This field is hidden when viewing the form
Program Type (old)
Brain Gym
Movement Facilitator
Movement Based Learning
LEAP
Program Type
*
Brain Gym
Movement Facilitator
Movement Based Learning
LEAP
License/Certification expiration date (BG)
MM slash DD slash YYYY
leave blank if you don't know
Annual Licensing/Membership Fee expiration date (BG)
MM slash DD slash YYYY
leave blank if you don't know
License/Certification expiration date (MF)
MM slash DD slash YYYY
leave blank if you don't know
Annual Licensing/Membership Fee expiration date (MF)
MM slash DD slash YYYY
leave blank if you don't know
License/Certification expiration date (MBL)
MM slash DD slash YYYY
leave blank if you don't know
Annual Licensing/Membership Fee expiration date (MBL)
MM slash DD slash YYYY
leave blank if you don't know
License/Certification expiration date (LEAP)
MM slash DD slash YYYY
leave blank if you don't know
Annual Licensing/Membership Fee expiration date (LEAP)
MM slash DD slash YYYY
leave blank if you don't know
This field is hidden when viewing the form
Current Number of Credits (BG)
This field is hidden when viewing the form
Current Number of Credits (MF)
This field is hidden when viewing the form
Current Number of Credits (MBL)
This field is hidden when viewing the form
Current Number of Credits (LEAP)
Check here if you do not want to be public on the website.
Check here if you do not want to be public on the website.
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country or Region
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country / Region
Enter Your Password
*
Your email will be used as your login username. Please enter your password here.
Enter Password
Confirm Password
This field is hidden when viewing the form
Member Program Profile
Brain Gym Program Title(s)
*
Brain Gym® Movement Facilitator
Instructor
Consultant
Faculty Intern
Faculty
International Faculty
Faculty Advisory Team
BTi Board Member
LEAP Program Title(s)
*
Instructor
Practitioner
Faculty
Advisory Board
BTi Board Member
Areas of expertise
*
Limited to 3 choices
Colleges/Universities
Corporate Trainings
Disabilities
Early Childhood Education
Elementary Education
High School Education
Learning challenges
Mental health (anxiety, depression, fears)
Occupational / Speech Therapies
Personal health & well-being
Professionals
Physical challenges
Seniors
Sports
Trauma
Veterans
Photo
Bio
Birthday
MM slash DD slash YYYY
Website
Facebook
Twitter
Instagram
Linkedin
WeChat
Δ
