Membership Application Form

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Membership application form

I am officially licensed or accredited as clinical psychologist.   I am officially licensed or accredited as clinical psychotherapist or medical doctor.   I am certified by IBRT.  

In case you have any difficulties filling out this form, please contact us.

After your application has been accepted, you will receive a confirmation and an invoice for the membership fee. Invoices can be paid by bank transfer, credit card or Paypal. The cost of paying by Paypal is an additional 5 euro.

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Resignation of membership needs to be addressed to the Board and send ultimately 3 months before the end of the business year. The business year runs from July 1 until June 30 of the next year.

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Fields marked with asterisk * are required.

EARTh Worldwide Regression Therapists