ABMT Membership Application Form

Name *

First Name Last Name

Email *

example@example.com

Address

Street Address

Street Address Line 2

City County

Postcode

Phone Number *

Area Code Phone Number

Date of Birth *

Date

Type of Membership being applied for *

Student Initial application for Full Practising Membership Associate (Qualified and non- practising Membership) Renewal of Full Practising Membership

Name of Training School

Cambridge Body Psychotherapy Centre Centre for Biodynamic Psychotherapy Other

Date training was completed

Date

Date training due to be completed

Date

Date training commenced

Date

Please add me to the ABMT closed facebook group

Yes No

Website:

Insurance Provider *

Policy renewal date *

Date

Name of Insurance provider

Policy Number *

Supervisor: *

Supervisor training / practise orientation *

I confirm that I have fulfilled the requirements of the ABMT CDP Policy in the my last year of membership. If this has not been possible please contact us directly. *

Yes No

Disclosure statement - Initial Full Membership If you have any doubts or concerns regarding your answers to any of the following questions please contact Lindsey Nicholas, Chair of the Association of Biodynamic Massage Therapists (ABMT) to discuss your application. *

I do not have any convictions, cautions, reprimands or final warnings that are not"protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions)Order 1975 (as amended in 2013)? Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website. Further information can also be found on the Nacro website. I have not been refused/expelled from membership of any professional body/register on the grounds of professional misconduct. I have not been suspended or placed under practice restriction by an employer or similar organisation because of concerns relating to your practice as a health care practitioner. I have not been disciplined by any professional body or membership organisation responsible for regulating or licensing a health or social care profession?

Disclosure statement - Renewal If you have any doubts or concerns regarding your answers to any of the following questions please contact Lindsey Nicholas, Chair of the Association of Biodynamic Massage Therapists (ABMT) to discuss your renewal application. *

I do not have any convictions, cautions, reprimands or final warnings that are not"protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions)Order 1975 (as amended in 2013)? Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website. Further information can also be found on the Nacro website. I have not been refused/expelled from membership of any professional body/register on the grounds of professional misconduct since my last renewal. I have not been suspended or placed under practice restriction by an employer or similar organisation because of concerns relating to your practice as a health care practitioner since my last renewal. Have you been disciplined by any professional body or membership organisation responsible for regulating or licensing a health or social care profession since your last renewal? I have not had any complaints made against me since my last renewal.

Continued Professional Development

I understand that there is a minimum requirement of 18 hours CPD in at least two of the categories stated in the Association’s Policy required during the associations annual period between October and the following September. If required I will provide a portfolio of evidence for auditing purposes. I agree to provide this within 3 months of the request. Please refer to the ABMT’s CPD Policy on the members page of the website for more information.

Data Protection:

The General Data Protection Regulation (GDPR) is an EU-wide legislation that came into effect on 25th May 2018 as the 2018 Data Protection Act. The data the ABMT holds about you includes your name, postal address, phone number, email address, practice website and address where relevant, the name of your insurer, and the name of your supervisor. We use this data to contact you for membership renewal, to disseminate information such as newsletters and notices about meetings, and when requested, for therapist practice listings on our website. For more information about this visit our website.

Membership Fees are payable to ABMT Bank Account

Sort code: 08-92-99 Account number: 65537194

Please use your surname as reference

Associate: £27.50

Full Member: £55

Associate Membership: By signing this form I confirm that: I am not currently practicing as a biodynamic massage therapist. If I start practicing as a biodynamic massage therapist I will upgrade my membership and ensure that I abide by the Code of Ethics, Supervision Policy and Continuous Professional Development (CPD Policy). These require me to have a supervisor and be insured. I confirm that I allow my data to kept for eight years from the end of my membership (the legal requirement) after which it will be erased from the ABMT’s records. *

Clear

Student Membership: By signing this form I confirm that: I am currently studying Biodynamic Massage. I have read the data protection policy and allow my data to kept for eight years from the end of my membership (the legal requirement) after which it will be erased from the ABMT’s records. That I will inform the ABMT if my circumstances change and I am no longer attending training. *

Clear

Full Membership: By signing this form I agree: I will abide by and work within the boundaries of the ABMT Code of Ethics. This document can be found on the members page of the website: www.abmt.org.uk. I have read the ABMT Data Protection Policy and allow my data to kept for eight years from the end of my membership (the legal requirement) after which it will be erased from the ABMT’s records. I agree to abide by ABMT CPD Policy I will inform the ABMT of any changes in circumstances that may affect my membership and / or my competency to practice as a Biodynamic Massage Therapist. *

Clear

Date

Please upload a copy of your insurance certificate

Please upload a copy of your course certificate and your insurance certificate

If you would like a photo in the Practitioner register please upload it here