Affiliate Application
Affiliate Application |
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Mr/Mrs/Miss/Ms* First Name ................................................................................................................................................. Surname ..................................................................................................................................................... Address ...................................................................................................................................................... .................................................................................................................................................................... Postcode..................................................................................................................................................... Phone................................................................. Email.............................................................................. Date of Birth.................................................... Occupation ............................................................................................................................................... Have you been in practice as a Hypnotherapist in the past? Yes No Do you intend to become a practicing Curative Hypnotherapist in the future? Yes No How did you find out about the OCH? ................................................................................................... I enclose my cheque for £10.00 (please make cheque payable to 'the OCH') I enclose my completed Bank Mandate As an Affiliate of the Organisation, I agree to abide by its rules as laid down in the Constitution and Code of Conduct and Ethics. (NB : If your application is unsuccessful, a full refund will be provided) Signed ................................................................................ Dated ............................. |
Bank Standing Order MandateBLOCK CAPITALS PLEASE To .............................................................................................................................. Bank (your bank) Address .................................................................................................................................................. Please debit my Account Number ............................................................... Sort Code......................... Account Name ......................................................................................................................................... Amount £ ............................. Amount in words ....................................................................................... On receipt of this Order and then ANUALLY until cancelled by me For Official Use Only Ref: .................................. and credit Account Number 70315354 Sort Code 20-05-00 Account Name The Organisation for Curative Hypnotherapists Bank Address PO Box 71, 8 Market Place, Basingstoke, Hampshire, RG21 7LY Signature................................................................................................................ Date....../......./......... Full Name (inc title)................................................................................................................................... Address..................................................................................................................................................... Please return your completed Bank Mandate to : The Organisation for Curative Hypnotherapists (OCH) |