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IAEBP Membership Application Form

1st August 2023 – 31st July 2024

Dear Successful Student – or returning Member

Welcome – or welcome back – to IAEBP Membership! This is your Application form.

When joining the IAEBP, you can pay your joining/Membership fees by credit card or from your bank by using PayPal (probably the easiest way for you), or you can pay by cheque (payable to ‘xxx’), or you can have bank account details and manage your own bank transfer.  Either way, just read and fill out the form below…. when you click the ‘send’ button, a fresh page will appear with details about how to pay – and how much. Please have a good read of all the sections on this page – for some sections you will be asked to verify that you have read and understood them. New IAEBP Members, or Members returning after a break, are subject to a one-off extra administration fee of £23 – this is already included in any fees stated. (Current yearly IAEBP Membership is £75 if paid promptly in the August renewal month).

Once I have received your completed form (and payment) I will ensure that you have full access to our online members support centre, the IAEBP Forum, where you can get details of our training seminars, download scripts, ask for advice, read the advice that’s been given to other members and generally chat, etc. You will also be able to apply to join our Facebook group, ‘The Padded Room – Post Therapy’. These days, the Facebook group has much more activity than the forum!

Welcome to our family!

Jonathan Manning

The Membership Form

Personal Details:

Name
Date of Birth

Home address incl. postcode

Main Work Address incl. postcode

Telephone:Home

Work

Mobile
Email address:
Web address
If you are renewing after a break (even if the break was just a few days) or joining for the first time, please state the date you obtained your diploma and details of the course you took. This includes details of any relevant courses, not just IAH/IAPH or Thrive courses.

Date Awarded Hypnotherapy/Psychotherapy Diploma and details of the course(s) you undertook.
Dates and details of any face to face training days you have attended including (most importantly) the number of hours of face to face training for each – and the total number of face to face training hours you have done so far. Please continue on separate sheet if necessary.
Have you had any criminal convictions? YES or NO
Are there any current criminal proceedings against you? YES or NO? If YES to either of the last two questions, please give brief details.
Are there any open or confirmed complaints against you through a professional body? YES or NO? If YES, please give brief details.
Have you experienced mental illness? YES or NO? If YES, please name the condition and describe any treatment you have had or are having for this.

I confirm that the information given above is true and accurate.
Please type in your name to confirm this

The next two questions refer to the ‘Membership Declaration’ below…

Please write ‘yes’ in the box on the right, if you accept the terms and conditions of the Membership Declaration
Please type in your name as you would like it to appear on your Membership Certificate e.g Rachel McClary

Membership Declaration:

Please read the following terms and conditions carefully, as you will be asked to verify that you understand and accept them:

I now make application to become a Member of the IAEBP and irrevocably undertake as hereunder: (i) Never to offer to help another person through the use of Hypnosis, Hypnotherapy or Psychotherapy, whether on the payment of monies or otherwise, unless first having in force an insurance against Professional Malpractice negotiated with an Insurance House of standing and repute. (ii) To forthwith discharge each client from treatment at the earliest possible opportunity consistent with their good care. (iii) Never to use hypnotic/post-hypnotic suggestion in an attempt to alleviate pain in another, unless each such procedure has been approved of by a qualified Medical Practitioner. (iv) Never knowingly to use hypnotic/post-hypnotic suggestion to gain an advantage from another of benefit to oneself and consequently to the detriment of the other person. (v) Never knowingly to use Hypnosis in any form or manner so as to be likely to bring discredit upon the use of Hypnosis as an aid to Therapy. (vi) Never to be involved in any Stage Performance where Hypnosis is used to provide solely a form of public amusement. (vii) To keep any interest in, or investigation of, the paranormal as totally separate from any work of Therapy using Hypnosis. (viii) At all times when using Hypnosis, Hypnotherapy or Psychotherapy, to exercise a diligent duty of care towards others.

Promoting Your Practice / Business:

FREE LISTING on the IAEBP website for full members:

Please list the Town/City that your practice is in and the full phone number for that practice: (List only Towns/Cities where you have an actual practice – NOT ‘other areas that I cover’)

1.
Town/City
Practice Phone Number
Web Site
Work email address
Social media links
2.
Town/City
Phone Number
You will be provided with a web-link from the IAEBP website to your own web site – this will improve the ranking of your own web site and make it easier for clients to contact you.  It helps us promote you if you have a link back to the IAEBP website  www.evidencebasedpsychotherapy.com from your own.  Your website should comply with Advertising Sandards Authority guidelines to be eligible for a weblink.

Disclosure and Barring Service (DBS) Checks (now mandatory for all Members)

Have you already undertaken an old-style CRB check or DBS for another employer?
If yes, what date AND check number are on it?
CRB/DBS Date
CRB/DBS Check Number
If you haven’t yet organised your DBS check, (the CRB as was) they now, by law, have to be arranged through IAEBP Head Office. Send me an email on admin@iaebp.com for more information.

Membership Level open to new Members

‘Member – Level One’ (Your membership certificate will say ‘Member’) – open to any person who has fullfilled the following criteria:

(1) Passed the Successful Hypnotherapy Diploma Course or another course approved by the IAEBP

(2) Undergone (or will undergo) a course of Personal Therapy as appropriate. (3) Undertaken (or will undertake) at least 20 hours of face to face training  (Continuous Professional Development) per year. (4) Has a current, valid CRB (Criminal Records Bureau) or DBS (Disclosure and Barring Service) Check. (Or is in the process of organising a DBS check)(5) Has current Professional Indemnity Insurance (or will have it in place before seeing first client) and will supply a copy of the certificate to head office. (6) Will subscribe to the IAEBP members forum and agree to keep its contents private and for sight of IAEBP members only.

N.B. Level One Membership applies to those new members who have completed a distance learning course but not yet completed 120 hours face to face training.  If you have completed a course with 120 hours face to face training, you will be eligible for a higher level and should contact head office – admin@iaebp.com

I meet and agree to the IAEBP Membership criteria, I have read and understand the current (2014) IAEBP Code of Practice and Ethics (click here to read) and I would like to apply for IAEBP Member – Level One status, from now until 31st July 2024
I meet and agree to the IAEBP Membership criteria, I am a returning member and I have read and understand the current (2014) IAEBP Code of Practice and Ethics (click here to read) and I would like to apply for IAEBP Full Member status, from now until 31st July 2024

Now please click the SEND button below – a fresh page will appear with paypal links and details of where to send a cheque to – so you can pay your dues.