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1 !"#$ % ( "! " +,) -% -./01 "233)'*'+/' 2444, 2 6 $ 26 & ' ) * 1

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6 MEMBERSHIP APPLICATION FORM ASSOCIATE AND CORPORATE MEMBERS INFORMATION FOR BAAT PURPOSES ONLY Title Forename Initial White Lion Street London, N1 9PD Surname Home Address Work Address Home Tel: Work Tel: Mobile: Please indicate with a tick if you do not wish to receive our monthly bulletin by At which address do you wish to receive BAAT correspondence? Home Work (Please choose one only) Membership Category (tick as appropriate) UK Associate Overseas Associate 8.00 Corporate 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 6

7 Please fill in the whole form including official use box using a ball point pen and send it to: The British Association of Art Therapists White Lion Street London N1 9PD Instruction to your Bank or Building Society to pay by Direct Debit Originator's Identification Number Reference Number Name(s) of Account Holder(s) 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 Bank/Building Society account number 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 DDI3 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 21 working 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. 7

8 ; 4 ". = %7%%7:, 1 " :4 : 4 7 #%!"!#0%-#'%&,"!"+%',"& '"( *+'& % Phillipa Brown University of Hertfordshire Department of Art Therapies Faculty of Art and Design College Lane Hatfield Hertfordshire AL10 9AB Tel: Web site: Tel: 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: Web site: Ms Caryl Sibbett Graduate School of Education Queen's University Belfast University Street Belfast, Northern Ireland BT7 1HL Tel: Web site: Art Therapy Training Course Department of Occupational Therapy and Art Therapy Queen Margaret University College Leith Campus Duke Street Edinburgh EH6 8HF Tel: Admissions for a prospectus, course leaflet and application form. Web site: To discuss an application please contact:: Margaret Hill (Admissions Tutor) Tel: Jonathan Isserow: Art Therapy Course Convenor Arts and Play Therapies Froebel College Roehampton University 80 Roehampton Lane London SW1 PU Tel: Nicholas D. Stein, School of Education, Health and Science, The University of Derby, Mickleover Campus, Derby, DE3 GX. Tel: Web Site: 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: General enquires: Course Administrator: Dean Middlebrook Website: Enquiries Office Roehampton University Roehampton Lane London SW1 PU Tel: (0) Website: 8

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