CPE Declaration Form – EMK Instructors

EMK Instructor Checklist:

Review the current EMK Instructor CPE Activity List – 40 points required over the two year period (scroll down to the bottom)
Complete and submit your EMK Instructor CPE Declaration Form below
Login to the new EMK Website Practitioner Profile and renew your EMK Practitioner and Instructor status for a further two year period. This will require you to complete the following:
- Upload your current Public Liability and Professional Indemnity Insurance Certificate
- Upload your current First Aid Certificate (required for all Active EMK Instructors)
- Agree to the recertification questions
- Process your Instructor recertification membership payment (which includes your EMK Practitioner renewal as well).
Once all information has been submitted to EMK Head Office, a new EMK Instructor Recertification Certificate will be issued for a further two year period.

Please note, all of the above needs to be completed and submitted in order to receive your new electronic EMK Instructor Recertification Certificate for a new two (2) year period, i.e. 1 December 2025 – 1 December 2027 and your status updated to ‘Active’ from 1 December 2025.

Please be mindful that the office will be inundated with CPE to be processed for everyone, so please be patient and allow up to 10 business days for your CPE to be finalised and new certificates issued.

We look forward to processing your EMK Instructor Recertification and recertifying you as an EMK Instructor.

CPE DECLARATION FORM

"*" indicates required fields

Name*

First Last

Email*

Address*

Address Line 1 City State / Province / Region Postal Code Country

Re-certification Two Year Period Requesting:

CPE Activity Period (previous two year period):

1st CPE Activity being claimed:

1st CPE Activity - Points being claimed:

1st CPE Activity - Evidence provided (* Documentary evidence to be uploaded to the CPE subfolder in the 'EMK Instructor Shared Folder' in Google Drive):

1st CPE Activity - Please provide details (i.e. EMK Course taught, other information or evidence provided):

2nd CPE Activity being claimed:

2nd CPE Activity - Points being claimed:

2nd CPE Activity - Evidence provided (* Documentary evidence to be uploaded to the CPE subfolder in the 'EMK Instructor Shared Folder' in Google Drive):

2nd CPE Activity - Please provide details (i.e. EMK Course taught, other information or evidence provided):

3rd CPE Activity being claimed:

3rd CPE Activity - Points being claimed:

3rd CPE Activity - Evidence provided (* Documentary evidence to be uploaded to the CPE subfolder in the 'EMK Instructor Shared Folder' in Google Drive):

3rd CPE Activity - Please provide details (i.e. EMK Course taught, other information or evidence provided):

4th CPE Activity being claimed:

4th CPE Activity - Points being claimed:

4th CPE Activity - Evidence provided (* Documentary evidence to be uploaded to the CPE subfolder in the 'EMK Instructor Shared Folder' in Google Drive):

4th CPE Activity - Please provide details (i.e. EMK Course taught, other information or evidence provided):

5th CPE Activity being claimed:

5th CPE Activity - Points being claimed:

5th CPE Activity - Evidence provided (* Documentary evidence to be uploaded to the CPE subfolder in the 'EMK Instructor Shared Folder' in Google Drive):

5th CPE Activity - Please provide details (i.e. EMK Course taught, other information or evidence provided):

Any additional comments / extra credits you are wanting to claim? (* Documentary evidence to be emailed to admin@bythebaykinesiology.com.au):

Total points claimed for period stated above (minimum 40 points required):

Declaration (Enter your full name as signature):

Dated submitted (DD/MM/YY):

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CPE Declaration Form – EMK Instructors

EMK Instructor Checklist:

CPE DECLARATION FORM

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