Division of Clinical Psychology faculty application form

Version: November 2011 /

Frequently asked questions

How long does the application process take?

Correctly completed applications will take approximately two weeks.

Can I email the form to the Society?

No. You must sign the form and send it with your payment to the Society

Contact details(Please complete using BLOCK CAPITALS and black ink)

If known, your BPS membership number
Surname Forenames
Title (Mr, Mrs etc)Date of birth
Address
Postcode
Email
Telephone Mobile

Declaration

I declare that the information provided is true and accurate.

Signed Date

Communication

E-mail addresses may be used by the Society to communicate with you, in addition to by post, in matters relating to your membership. To be included in these, you must have an email address registered with us and have ‘opted in’ to receiving communications by email from the Society –for further details:

Many faculties also have email discussion and announcement lists. Please indicate whether you would like to join any relevant Faculty discussion lists (You will need to include an email address on this form to be added.)

Yes No 

Please note,you are free to leave the discussion lists at any time.

Categories of Membership

Applicants will automatically be assigned the relevant level of membership according to their Society Membership or Subscription:

‘Full Member’ shall include Full Members of the Division of Clinical Psychology.

‘Affiliate’ shall include General (Assistant) and In Training members of the Division of Clinical Psychology.

‘Associate’ shall include individuals who are General members of the Division of Clinical Psychology and non members of the Division

PaymentDue to the administrative costs involved, the Society will only process applications where the full payment has been made.

Fees advertised are subject to change. You canpay by cheque, postal order or card.If you have already signed up for Direct Debitwith the Society, then your payment will be added to the Direct Debit process.

Please circle the Faculty/s you would like to join in the space provided and add the relevant fee to your payment.

Faculty for Addictions / Full £20.00
Associate £10.00
Affiliate £10.00 / Faculty for Learning Disabilities / Full £15.00
Associate £15.00
Affiliate £15.00
Faculty for Children & Young People (CYP) / Full £30.00
Associate £15.00
Affiliate £15.00 / Faculty for Oncology and Palliative Care (SIGOPAC) / Full £10.00
Associate £10.00
Affiliate £10.00
Faculty of Clinical Health Psychology (FacCHP) / Full £10.00
Associate £10.00
Affiliate £5.00 / Faculty for Perinatal Psychology / Full £15.00
Associate £15.00
Affiliate £15.00
Faculty for Eating Disorders / Full £15.00
Associate £20.00
Affiliate £10.00 / Faculty of Psychosis & Complex Mental Health (PCMH) / Full £15.00
Associate £15.00
Affiliate £10.00
Faculty of Forensic Clinical Psychology / Full £15.00
Associate £15.00
Affiliate £15.00 / Faculty for Psychology Specialists Working With Older People (PSIGE) / Full £30.00
Associate £30.00
Affiliate £10.00
Faculty for Holistic Psychology / Full £10.00
Associate £10.00
Affiliate £10.00 / Faculty of Race and Culture / Full £10.00
Associate £15.00
Affiliate £5.00
Leadership and Management Faculty / Full £15.00
Associate £15.00
Affiliate £15.00 / Faculty for Sexual Health and HIV / Full £15.00
Associate £15.00
Affiliate £10.00

Faculty Networks

The ChildrenYoung People and Psychosis & Complex Mental Health Faculties have networks. Membership of these networks is FREE to members of the respective faculties. Please tick which networks you would like to join:

CYP Faculty networks PCMH Faculty networks

Paediatric network / Crisis Resolution Home Treatment (CRHT)
Clinical Psychologists working with looked after children / Family Interventions Special Interest Group Psychosis & CMHT network
Children with learning disabilities / Social Inclusion Network
Forensic / Network of Assertive Outreach Psychologists
Early Intervention in Psychosis Network
Inpatient Psychological Practitioner Network
Rehabilitation & Recovery Services Network

Total

I enclose cheque/postal order payable to The British Psychological Society for £______or:

Please charge my credit/debit card £______

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Name of cardholder
Cardholder’s signature

Card issuer(unfortunately we cannot accept Visa Electron or Solo cards)

Please circle – Visa Amex MasterCard Delta Switch/Maestro

Card Number:
Valid From: / Expiry Date: / Issue No(switch only): / Three/four digit CVV number*:

*Visa, MasterCard, and Maestro, the CVV code is the last three-digit number located on the back of your card on or above your signature line. American Express, it is the four-digit number on the front.

Completed forms and payment to be sent to:

British Psychological Society, PO Box 87, Oakengates DO, TF3 3WT

Visit our website for more detailed information or get in touch by:

e: t: +44 (0)116 252 9537