Application for Membership
Application for Membership |
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Mr/Mrs/Miss/Ms* First Name ................................................................................................................................................. Surname ..................................................................................................................................................... Practice Name ........................................................................................................................................... Home Address ........................................................................................................................................... If/when accepted into Membership I agree to my practice details being available to the public How did you find out about the OCH? ..................................................................................................... How long have you been in practice? ......................................................................................................Is your practice full or part time? ............................................................................................................ As we can accept into membership only those practitioners who have gained recognised qualifications, it is necessary that full details be provided of your training and/or qualifications. Therefore please ensure you also complete the second page of this form. If your qualifications are unknown to the Organisation, we will need to contact your training/examination bodies in order to be able to assess their suitability for acceptance, therefore the more information you supply, the quicker we will be able to process your application for Membership of the OCH. I enclose my cheque for £25.00 (please make cheque payable to ‘the OCH’) I enclose my completed Bank Mandate If your application is unsuccessful, a full refund will be provided. |
Personal DetailsRelevant courses undertaken.................................................................................................................... Postal address of training establishment.................................................................................................. Website address of training establishment.............................................................................................. Length of course........................................................................................................................................ Course structure (classroom based/distance learning etc)..................................................................... Relevant qualifications ............................................................................................................................. Postal address of examination body (if applicable).................................................................................. Website address of examination body...................................................................................................... Examination structure (written/invigilated,written/home based,
oral, practical etc).............................. Qualification gained................................................................................................................................... Other organisations currently a member of............................................................................................. Present/previous occupation..................................................................................................................... As a Member of the Organisation, I agree to abide by its rules as laid down in the Constitution and Code of Conduct & Ethics, and conform to those methods of treatments recognised by the OCH. I enclose:- Signed ....................................................................................... Dated .............................. As membership of any professional hypnotherapy organisation involves holding appropriate professional indemnity insurance, signing this form confirms that you are covered by a valid, current policy. |
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) |