| NAME : |
_______________________________________________ |
| ADDRESS : |
_______________________________________________ |
| POST CODE : |
_______________________________________________ |
| TELEPHONE : |
_______________________________________________ |
| EMAIL : |
_______________________________________________ |
| WEBSITE : |
_______________________________________________ |
If you do not wish your contact details to be shared with other members of PCT Scotland, other than the Secretary and Website Administrator, please tick here [ ] (1)
Please circle and complete where applicable:
I wish to apply for Full /
Associate / Affiliate / Student
membership of PCT Scotland
(2)
I am a member of BACP / COSCA /
BPS / UKCP / AHPP or __________________ (3)
My membership ID number(s) of the above is/are
___________________________ (4)
I have completed / am currently on a recognised person centred training course at
_______________________________________________________________ (5)
If applying through sponsorship, please give the names of your two sponsors.
(6)
_____________________________ and _____________________________
I enclose a Cheque / have arranged a Standing Order for my membership fee of:
£40.00 (Full) / £40.00 (Associate) / £24.00
(Affiliate) / £12.00 (Student). (7)
I have included a contribution of £____________ to the Access Fund. (8)
I require / do not require a receipt for the above payment(s).
I have read the Information Sheet and Membership Criteria and
confirm that I understand the conditions of membership and meet all the requirements of the category for which I
am applying. Further, I consent to my personal details being held in the manner outlined in
PCT Scotland's Data Protection Policy. (9)
Signed .................................................
Date .........................
|