memberform1

All fields must be filled out in full before submitting the form Please send a recent, passport size, photograph with your application.

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):
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:
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.

	Please send your photographs and proof of qualifications to: Brenda Diskin, 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.