Application for Student Membership

Mr/Mrs/Miss/Ms*

First Name ...............................................................................................................................................
Surname ..................................................................................................................................................

Address ...................................................................................................................................................
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Postcode...................................................................................................................................................
Phone................................................... Email..........................................................................................
Date of Birth............................................................................................................................................

Relevant Qualifications (inc. date received).............................................................................................
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Present*/Previous* Occupation .............................................................................................................
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Current Training

Relevant courses undertaken (inc. length of course & start date)............................................................

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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

As a Student Member of the Organisation, I agree to abide by its rules as laid down in the Constitution and Code of Conduct & Ethics. I understand that Student Membership applies for a maximum of one year, after which I may apply to join as a practicing Member or Affiliate.

Signed ..................................................................................... Dated ....................................................

For OCH purposes only :
Phone No (daytime) ………….....………………...... (evening) ……………………......…................…..