memberform


incorporating Yorkshire Mediums

Affiliated to

Healer Practitioner Association International

Click here to view independent verification of my insurance cover

Dedicated to raising the standards of Healers and Mediums everywhere. We welcome membership and insurance enquiries from all Spiritual Workers everywhere in the UK.

We are here for you.

MEMBERSHIP & INSURANCE

NEWS & INFORMATION

OUR SISTER SITES

Membership Form

PRINTABLE VERSION

If you are paying for multiple items e.g. Insurance, courses and membership you can pay the full amount for all with the donation button just make sure you fill out and submit the membership form please

All fields must be filled out in full before submitting the form. If you are applying for 'Couple Membership' you must both fill out the membership form and state the other parties name in the comments box. For SYH or YM membership please send a recent, passport size, photograph for each member with your application (2 photos if you applying for both SYH & YM membership).

Title:

Name:

Date of Birth:

dd/mm/yyyy

Sex:

M: F:

House name or number and street:

Postcode:

Telephone:

Email Address:

Website URL:

Membership Type:

Member of Other Group or Organisation?:

No: Yes: If yes state which:

Qualifications (copies of these will be required):

If you are a Medium or Psychic please supply 3 references preferably from churches or centres where you have worked in this capacity or from clients you have given a paid consultation to ( not family or friends - references will be checked).

Reference 1:
Reference 2:
Reference 3:

Other Relevant Information:

Have you ever had a criminal conviction?

Yes: No:

If you answered yes, please give details:

Do you currently hold a Professional Indemnity insurance?

Yes: No:

Have you ever been refused insurance cover?

Yes: No:

If you answered yes to either of the above, please give details:

Criminal Records Form - Please download and print this form, fill in, sign and return to us by post.

Download

Place of Birth:

Are you a British citizen?:

Yes: No: If "No" please give details.

Are you interested in any of the following? (check box) :

Workshops: Courses: Readings: Healing:

Paranormal Investigations: Other: Please state what:

Comments:

Do you want to place an add on our websites? (Full members only):

No: Yes: If yes please use contact form to send us details.

SYH or it's founders reserve the right to refuse or revoke membership at anytime without prior warning if deemed necessary..

Please send your photographs, proof of qualifications and copies of any currently held CRB disclosures and your completed ISA form to:

Brenda Diskin, Secretaary SYH, 194 Lindsay Avenue, Old Parson Cross, Sheffield, South Yorkshire, S5 7SG (or e-mail to sacredearth2@hotmail.com)

Please DO NOT send any cheques to cover insurance payable to me please contact me first.