Faculty application form Frequently asked questions How long does the application process take? Correctly completed applications will take approximately two weeks. Contact details (Please complete using BLOCK CAPITALS and black ink) If known, your BPS membership number Surname Forenames Title (Mr, Mrs etc) Date of birth Address Postcode Email Telephone Mobile Declaration I declare that the information provided is true and accurate. Signed Date Communication E-mail addresses may be used by the Society to communicate with you, in addition to by post, in matters relating to your membership. To be included in these, you must have an email address registered with us and have ‘opted in’ to receiving communications by email from the Society – for further details: www.bps.org.uk/help-centre Many faculties also have email discussion lists. Please indicate whether you would also like to join any relevant discussion lists (You will need to include an email address on this form to be added.) Yes No Please note, you are free to leave the discussion lists at any time. Categories of Membership Applicants will automatically be assigned the relevant level of membership according to their Society Membership or Subscription: ‘Full Member’ shall include Full Members of the Division of Clinical Psychology. ‘Affiliate’ shall include General (Pre-Training) and In-Training members of the Division of Clinical Psychology. ‘Associate’ shall include individuals who are General members of the Division of Clinical Psychology and non members of the Division. Payment Due to the administrative costs involved, the Society will only process applications where the full payment has been made. Fees advertised are subject to change. You can pay by cheque, postal order or card. If you have already signed up for Direct Debit with the Society, then your payment can be added to the Direct Debit. Please circle the Faculty/s you would like to join in the space provided and add the relevant fee to your payment. Faculty for Addictions Faculty for Children, Young People and their Families (CYPF) Faculty of Clinical Health Psychology (FacCHP) Faculty for Eating Disorders Faculty of Forensic Clinical Psychology Faculty for Holistic Psychology Leadership and Management Faculty Full £20.00 Associate £10.00 Affiliate £10.00 Full £30.00 Associate £15.00 Affiliate £15.00 Full £10.00 Associate £10.00 Affiliate £5.00 Full £15.00 Associate £20.00 Affiliate £10.00 Full £15.00 Associate £15.00 Affiliate £15.00 Full £10.00 Associate £10.00 Affiliate £10.00 Full £15.00 Associate £15.00 Affiliate £15.00 Faculty for People with Intellectual Disabilities Faculty for Oncology and Palliative Care (SIGOPAC) Faculty for Perinatal Psychology Faculty of Psychosis & Complex Mental Health (P&CMH) Faculty of the Psychology of Older People Faculty for Sexual Health and HIV Full £15.00 Associate £15.00 Affiliate £15.00 Full £10.00 Associate £10.00 Affiliate £10.00 Full £15.00 Associate £15.00 Affiliate £15.00 Full £15.00 Associate £15.00 Affiliate £10.00 Full £30.00 Associate £30.00 Affiliate £10.00 Full £15.00 Associate £15.00 Affiliate £10.00 Faculty Networks The Children, Young People & their Families (CYPF), Psychosis & Complex Mental Health (P&CMH) and Clinical Health Psychology (FacCHP) faculties have networks. Membership of these networks is FREE to members of the respective faculties. Please tick which networks you would like to join: CYPF Faculty networks Paediatric network Clinical Psychologists working with looked after children Children with learning disabilities Forensic Forum for Inpatient Child & Adolescent Psychology Services Psychologists working in Schools Infant Mental Health Network P&CMH Faculty networks Rehabilitation & Recovery Services Network Family Interventions Special Interest Group CMHT network Social Inclusion Network Network of Assertive Outreach Psychologists Early Intervention in Psychosis Network Acute and Crisis Network FacCHP networks Cardiac Diabetes Obesity Paediatric HIV Pain Renal Respiratory Visit our website http://dcp.bps.org.uk/networks for more detailed information about each Faculty or get in touch by e: MemberNetworkServices@bps.org.uk t: +44 (0)116 252 9515 Total If you have a direct debit set up with the Society, this amount can be paid for using this method. Please tick if you would like your Faculty subscription adding to this or: I enclose cheque/postal order payable to The British Psychological Society for £________ or: Please charge my credit/debit card £________ (please see next page to enter credit/ debit card details) Name of cardholder Cardholder’s signature Card issuer (unfortunately we cannot accept Visa Electron or Solo cards) Please circle – Visa Amex MasterCard Delta Switch/Maestro Card Number: Valid From: Expiry Date: Issue No (switch only): Three/four digit CVV number*: *Visa, MasterCard, and Maestro, the CVV code is the last three-digit number located on the back of your card on or above your signature line. American Express, it is the four-digit number on the front. Completed forms and payment to be sent to: British Psychological Society, PO Box 87, Oakengates DO, TF3 3WT