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 [email protected] 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 have an interest in EMDR therapy and would be eligible to be trained in EMDR therapy (as described on the EMDRAA website). I acknowledge that I am unable to be listed on the EMDRAA Find a Therapist page, am unable to vote at the EMDRAA AGM and I am not eligible to be nominated to the EMDRAA Board, but that I have other rights and responsibilities as outline in the EMDRAA Constitution. Declaration* I agree to the declaration as outlined above.
