Professional Membership & Training Sign-Up Form

SECTION 1 — CONTACT DETAILS

Full Name (required)

Job Title (required)

Organisation / Practice Name

Email Address (required)

Phone Number

Location (City / Country)

SECTION 2 — PROFESSIONAL BACKGROUND

Which best describes you?
Wellbeing PractitionerTherapist/Counsellor/PsychotherapistCoach/MentorHealthcare ProfessionalEducation ProfessionalHolistic PractitionerStudentOther

Area of Specialism

Years of Experience
0–23–56–1010+

SECTION 3 — WHAT WOULD YOU LIKE TO JOIN? (Required)

Professional Membership — Monthly (£35)Professional Membership — Annual (5% discount)Training Course (£99)Training + MembershipNot sure — please advise

SECTION 4 — TRAINING INTEREST

Select all that apply:
Send all upcoming training datesTrauma-informed practiceSafeguarding & professional practiceCPD workshopsWellbeing practitioner trainingOther

If Other, please specify:

Preferred format:
OnlineIn personNo preference

Questions or requirements:

SECTION 5 — PAYMENT METHOD

How would you like to pay?
Card payment (Stripe link sent)Bank transfer / invoiceOrganisation paying

If organisation paying:

Organisation Name

Accounts Email

PO Number

SECTION 6 — CONSENT

I agree to be contacted with membership, training dates and payment links
I understand membership begins once payment is received
I would like future training & professional updates

Typed Name (Signature)

Date

Δ