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MEMBERSHIP APPLICATION FORM

ASSOCIATE AND CORPORATE MEMBERS

INFORMATION FOR BAAT PURPOSES ONLY

Title

Forename

Initial

Surname

Home Address

Work Address

Home Tel:

Work Tel:

Mobile:

E-mail:

Please indicate with a tick if you do not wish to receive our monthly bulletin by email

At which address do you wish to receive BAAT correspondence? Home

Work

(Please choose one only)

Membership Category

(tick as appropriate)

UK Associate

£70.00

Overseas Associate

£85.00

Corporate

£140.00

Payment method (please tick): Cheque

Direct Debit

Payment frequency (for Direct Debit only): Yearly / Quarterly (delete as appropriate) If paying by cheque you must make a single annual payment Amount enclosed

If paying by Direct Debit please complete the attached Direct Debit Mandate form. If you have an existing standing order in favour of BAAT, please make sure that you complete the section cancelling the standing order

Signature

Date

24-27 White Lion Street London, N1 9PD

020 7686 4216

(7)

Instruction to your

Bank or Building Society

to pay by Direct Debit

Please fill in the whole form including official use box using a ball point pen

and send it to: Originator's Identification Number

6 8 6 8 9 6

Reference Number

The British Association of Art Therapists 24-27 White Lion Street

London N1 9PD

Name(s) of Account Holder(s)

Bank/Building Society account number

FOR BAAT OFFICIAL USE ONLY

This is not part of the instruction to your Bank or Building Society. PLEASE INSERT YOUR NAME AND ADDRESS IN THIS BOX

Branch Sort Code

Name and full postal address of your Bank or Building Society

To: The Manager Bank/Building Society

Instruction to your Bank or Building Society

Please pay The British Association of Art Therapists Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with The British Association of Art Therapists and, if so, details will be passed electronically to my Bank/Building Society.

Address Signature(s)

Postcode Date

Banks and Building Societies may not accept Direct Debit Instructions from some types of account

This guarantee should be detached and retained by the Payer.

The Direct Debit Guarantee

• This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank and Building Society.

• If the amounts to be paid or the payment dates change The British Association of Art Therapists will notify you 21working days in advance of your account being debited or as otherwise agreed.

• If an error is made by The British Association of Art Therapists or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid.

• You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.

(8)

; 4 " . = % 7 % % 7 : , 1 " 5 : 4 : 4 7 5

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Phillipa Brown University of Hertfordshire

Department of Art Therapies Faculty of Art and Design

College Lane Hatfield Hertfordshire AL10 9AB

Tel: 01707 285339 e-mail: [email protected]

Web site: www.herts.ac.uk

Tel: 01707 284800 Admissions for a prospectus

Terry Molloy Art Psychotherapy Unit of Psychotherapeutic Studies Professional and Community Education

Goldsmiths - University of London

23 St James, New Cross London SE14 6AD Tel: 020 79197230 e-mail: [email protected] Web site: www.goldsmiths.ac.uk Ms Caryl Sibbett

Graduate School of Education

Queen's University Belfast

69-71 University Street Belfast, Northern Ireland BT7 1HL

Tel: 028 9097 5923 e-mail: [email protected]

Web site: www.qub.ac.uk

Nicholas D. Stein,

School of Education, Health and Science,

The University of Derby,

Mickleover Campus, Derby, DE3 5GX. Tel: 01332 592009 E-Mail: [email protected]

Web Site: http://ibs.derby.ac.uk/therapeutic-arts Dr Chris Wood

Northern Programme for Art Psychotherapy

Sheffield Care Trust and Leeds Metropolitan University

Netherthorpe House 101 Netherthorpe Road

Sheffield S3 7EZ

Enquiries about applications: 0114 2264901 General enquires: 0114 2264900 Course Administrator: Dean Middlebrook

[email protected] Website: http://www.sct.nhs.uk/arttherapy/html Art Therapy Training Course

Department of Occupational Therapy and Art Therapy

Queen Margaret University College

Leith Campus Duke Street Edinburgh EH6 8HF

Tel: 0131 317 3239

Admissions for a prospectus, course leaflet and application form.

Web site: www.qmuc.ac.uk/courses/pg_artth.htm To discuss an application please contact::

Margaret Hill (Admissions Tutor) e-mail: [email protected]

Tel: 0131 317 3350

Jonathan Isserow: Art Therapy Course Convenor Arts and Play Therapies

Froebel College Roehampton University 80 Roehampton Lane London SW15 5PU Email: [email protected] Tel: 02083923118 Enquiries Office Roehampton University Roehampton Lane London SW15 5PU Tel: (0)20 8392 3232 Email: [email protected] Website: http://www.roehampton.ac.uk/pg/at/

(9)

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