Membership Application

A. Basic Information

Name of the Institute (required)
Country (required)
E-mail (required)
Treasurer e-mail (if different)
Address (required)
Postal Code
Telephone
Fax
Website

B. Your Institute is applying to become:

Full MemberAssociate Member

C. Two letters of recommendation are required to support your application.

a) Directors or senior staff of EFTA-TIC member institutes or

b) Senior family therapists or trainers. (It is not essential that they be EFTA members).
The referees must not be employed by or closely associated with the applicant institute.
It is desirable that one reference be from a local source in your own country and one international source.

2 EFTA-TIC Member Institutes2 Senior Family Therapists/Trainers1 of each

C.I. EFTA-TIC Member Institutes

Institute #1

Name of Institute
Director(s)
Address
Country
Postal Code
Telephone
Fax
E-Mail
Website

Institute #2

Name of Institute
Director(s)
Address
Country
Postal Code
Telephone
Fax
E-Mail
Website

C.II. Senior Family Therapists / Trainers

Senior Family Therapist / Trainer #1

Name
Institute Affiliation
Address
Country
Postal Code
Telephone
Fax
E-Mail

Senior Family Therapist / Trainer #2

Name
Institute Affiliation
Address
Country
Postal Code
Telephone
Fax
E-Mail

D. Documents Enclosed

completed Application Form,the statutes of the Institute,an overview of the training program,the number of professionals already trained,the names of the trainers in the institute, and information on their own training,collaborations with other Institutes (if any),2 letters of recommendation from application supporters (must be independent of applying institute)

D.I. Attachment

Attach zip file:(only .zip file)

Application Fee Enclosed

120 EURO Full Membership60 EURO Associate Membership40 EURO Low-Income Country Membership

I hereby declare that the information stated in this application is correct.

On behalf of the Institute
Name
Position in the Institute