Please print, complete and send this form to:
Standing Membership Committee Secretary,
UK EAPA, 3 Moors Close, Ducklington, Witney, Oxford, OX29 7TW

MEMBERSHIP GRADES AND ANNUAL FEES (Please read in conjunction with the Criteria)

I wish to apply for the following grade:

(NB The membership year starts on 1 January. A pro rata amount will be invoiced on joining part way through a year, provided this amount is not lower than £40.00. Membership fees shown are current at time of publication.)

CONTACT DETAILS (to be completed by all applicants)

NAME
____________________________________________

COMPANY
____________________________________________

ADDRESS
____________________________________________
 
____________________________________________
 
____________________________________________
 
____________________________________________
 
______________________POSTCODE_____________

PHONE
____________________________________________

FAX
____________________________________________

EMAIL
____________________________________________

WEBSITE
____________________________________________

I agree that my contact details and any subsequent amendments to them may be used for publication (including the website) so that they are available to:

(TICK PREFERRED)

MEMBERSHIP OF PROFESSIONAL BODIES (to be completed by all applicants)

For all grades (other than Organisational Membership)

Tick which professional body you are a member of and give membership number and grade of membership:

If you are applying for External/Internal Provider Membership please state
NAME of 2nd nominee:
____________________________________________________________________

and provide evidence that you are meeting all the relevant membership criteria 1-11 for a Registered External/Internal Provider. For a  Registered External Provider you will also need to complete the Standards Self-verification form. This form will be subject to audit.

If you are applying for Individual Membership only:

Please state which sub-category you wish to be listed under (you can be listed under more than one if appropriate).

* If electing for this sub-category you will need to provide written confirmation from your employer/accountant that you are employed/contracted to work at least 50% of your time in the role of EAP account manager/client services manager/programme manager.

N.B. All members will receive free copies of the UK Standards of Practice and Professional Guidelines for EAPs, UK Purchasing Guidelines for EAPs and UK Guidelines for Audit and Evaluation of EAPs and will be expected to adhere to them. If this causes you any difficulty you are expected to inform us within 1 month of your membership.

SIGNED DECLARATION (to be completed by all applicants)

I agree to adhere to EAPA's Code of Ethics and UK Standards of Practice and Professional Guidelines for Employee Assistance Programmes. (Your details and adherence to the Code and Standards will be subject to audit.)

I authorise checks to be made on information contained in this application and any subsequent amendments to the details.

SIGNATURE_________________________DATE________________________  

Completion of this section is OPTIONAL:

If a current member introduces your application they will be entitled to money off their next year's membership subscription.
A current member supports my application:

NAME______________________________GRADE__________________

ADDRESS___________________________________________________
 
_____________________________________________________
 
_____________________________________________________
 
_____________________________________________________