Follow the four steps to renew your membership of BAPT

BAPT Membership Renewal

1st October 2015 to 30th September 2016

You can return this form by email or by post.

1)PAYMENT

I enclose my cheque for £35.00, made payable to The British Association of Play Therapists. Please write your name and member number on the reverse of the cheque.

I have transferred the sum of £35.00 by Internet bank transfer toHSBC, Sort Code: 40-30-24, A/C No: 41808591, A/C Name: British Association of Play Therapists, quoting membership No Please ensure you quote your membership number or we will be unable to identify who the payment is from.

I will pay £35.00 by Standing Order. Please arrange this through you own bank, giving them the following details: HSBC, Sort Code: 40-30-24, A/C No: 41808591, A/C Name: British Association of Play Therapists Payments should be made on the 1st October each year.Please ensure you quote your membership number or we will be unable to identify who the payment is from.

I will pay by Pay Pal via the website.Please note that a small additional fee applies for Paypal payments but ensure you quote your membership number or we will be unable to identify who the payment is from

GIFT AID

Please treat this payment and any payments made in the future as Gift Aid donations. Or,

 Please treat this payment and any payments made in the last 6 years or any future payments made as Gift Aid donations.

Please return this form either by email or post to the office address:

1 Beacon Mews, South Road, Weybridge KT13 9DZ

An administration charge of £10.00 will be made on all payments AFTER31 October 2014.

2)YOUR DETAILS

Please completeany changes to the details below in block capitals. All information is held in confidence and will only be used for BAPT related activities. Your name and address will not be passed to any third party.

NameMembership no.

Address:

Email Address:

Home Telephone:

Work Telephone:

Mobile:

Continued…….

3) DETAILS OF YOUR SUPERVISOR

a) Supervisor’sname and address:

b) Is your Supervisor BAPT registered? Yes No

Ifyour supervisor is not BAPT registered or a BAPT member, they should meet the BAPT criteria set out on the website.

4)MEMBER DECLARATION

Please read and confirm the following:

a)I do not have a criminal record that may prejudice the interests of children.

b)I have not been dismissed from employment on the grounds of professional misconduct or lack of competence

c)Since my last registration there has been no change relating to my good character (this includes any conviction or caution, if any, that you are required to disclose), or any change to my health that may affect my ability to practise safely and effectively

d)I have not been refused membership of a professional body or register in a related field on the grounds of professional misconduct or lack of Competence.

e) I have read and will abide by the criteria defined in the Code of Ethics and Practice of the British Association of Play Therapists.

f) I have a current CRB/DBS (issued less than 3 years ago) for my Play Therapy work:

CRB Number

Date of Issue ……………………………

Member signature

Date

If you cannot confirm one or more of the above statements, please advise details on a separate sheet. We will contact you to discuss further but please note that failure to comply with these requirements within 12 weeks of renewal may result in your membership being suspended or terminated.