Join EMDRAA - Associate Membership application form for EMDRAA Associate Membership Name* Mr.Mrs.MissMs.Mux.Dr.Prof.Rev. Prefix First Last Email* Date of Birth*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920For account identification purposesProfession & Registration*Select an optionCounsellorClinical NeuropsychologistClinical PsychologistFamily TherapistForensic PsychologistMedical DoctorMental Heath NurseOccupational TherapistProvisional PsychologistPsychiatric NursePsychiatristPsychologistPsychotherapistSocial WorkerOtherIf the selection you are looking for is not displayed, please contact EMDR Association of Australia Ltd by emailing secretary@emdraa.org with your enquiry.Other Profession*List your profession not noted in the list above and you will be contacted to clarify.Type of Counsellor*Select an optionCounsellor-Psychotherapist PACFACounsellor PACAWACounsellor NZCounsellor ACAOther CounsellorType of Social Worker*Select an optionMental Health / Clinical Social WorkerSocial Worker - OtherHighest Qualification*Year Awarded Highest Qualification*Institution Awarding Highest Qualification*Do you carry Professional Indemnity Insurance?*Select an optionYesNoCovered by EmployerNot ApplicableBy proceeding with this Application for Associate Membership I declare I consent to becoming a member of EMDRAA Ltd which is a company limited by guarantee. By proceeding with this Application for Associate Membership I declare I am partially trained to EMDRAA standards, and that I do not have voting rights, cannot list my details on the EMDRAA Find a Therapist service, and cannot stand for election to the Board, but have other other rights and responsibilities as outlined in the Constitution.Declaration* I agree to the declaration as outlined above.
