Association Membership

Application Form for Membership

Title *

Title (If Other Selected)

Forename *

Surname *

Address Line 1 *

Address Line 2

Address Line 3

Postcode (to be used for "Find a therapist" database) *

Telephone (Day) *

Telephone (Eve) *

Mobile

Email *

Website

Occupation *

Date Of Birth (DD/MM/YY) *

Qualifications *

Please note the entry qualifications for each type of membership. Please enclose a copy of all relevant certificates

File upload

CPD completed in the last 12 months (20 hours required for membership):

Insurers

Policy Number

Expiry Date (DD/MM/YY)

File upload

I wish to apply for the following category of membership:

Full

Student

I have enclosed copies of my relevant diploma certificates and insurance.                    *

I confirm that I have paid £10 by online bank transfer or I have sent a cheque (See details below). *

I confirm that I am happy for my details to be entered into the "Find a therapist " database *

I confirm that I am happy to receive information on forthcoming courses and other relevant information