Application Form For ISTDP-UK Membership & Affiliate Status

Name/Title

Address

Email address
Telephone    
Home                                                                              
Mobile                                                               

Membership (Tick)   Full  …                       Associate  …             Affiliate  …

Qualifications

Current Accrediting Organisation
Registration Number

I confirm I do not have any complaints or pending complaints lodged against me and I am regarded as being of ‘good standing’ by my accrediting organisation.
I consent to the use of the above information for the administration and internal use of ISTDP-UK.
I agree to abide by the Constitution and Rules of ISTDP-UK and have included the relevant fee with this application.

I

Signature…………………………………                          Date………………….

Please print and send to:

ISTDP-UK

Administrator

26 Freegrove Road,

London,

N7 9RQ