ࡱ>  bjbjr r .>`_`_  ~~~~~TT+,::ttttccc +++++++$-o062+~ccccc2+~~ttG+OOOcv~t~t +Oc +OOt'*p* v)*]+0+)1O1$**\1~\*ccOccccc2+2+Occc+cccc1ccccccccc X D: Membership Application Form Allied Health Professional Membership Introduction: Membership is available for Allied Health Professional Membership based in the United Kingdom / Republic of Ireland. The category provides access to all BPNA activities including: Special Interest Groups, Teaching on Short Courses, access to recorded Webinars and meetings and conferences at members rate. Membership does not grant voting rights. Who this applies: UK & Republic of Ireland Specialist Nurses /Advanced Nurse practitioners UK & Republic of Ireland Physiotherapists Psychologists UK & Republic of Ireland Occupational therapists UK & Republic of Ireland Speak and Language therapists UK & Republic of Ireland Neurophysiologists Other UK & Republic of Ireland Therapist positions Other UK & Republic of Ireland based Allied Health Professionals Instructions: Please email Philip Levine at  HYPERLINK "mailto:philip.levine@bpna.org.uk" philip.levine@bpna.org.uk or telephone +44 (0)208 037 4747 if you experience any difficulties. a) On your browser click File and then Save As. Save this form to your computer. Save the file again as File Name: your name and File Type: Word Document a) Complete the sections on the form Put your latest position below and inform us of any other relevant information that maybe useful to us when considering your application Personal statement (why would you like to join?) Max 250 words Resave the document. 3. Email the completed document as an attachment to:  HYPERLINK "mailto:philip.levine@bpna.org.uk" philip.levine@bpna.org.uk 4. Download the direct debit form from the BPNA website and send by post to the BPNA Accounts (address below). We must have the physical original form to send to the bank. Faxed or scanned copies are not acceptable. Send your Direct Debit form to: BPNA Accounts The Coach House Rear of 22 Chorley New Road Bolton BL1 4AP Personal Details: Title: Full Name: Current Position: Place of Work: Address for correspondence: Work Telephone: Mobile: Email: Details of your Proposer Please note your proposer must be a BPNA member. If you dont know a BPNA member please contact  HYPERLINK "mailto:philip.levine@bpna.org.uk" philip.levine@bpna.org.uk Name of Proposer: Place of Work: Email: At the AGM held on Thursday 28 January 2016, the BPNA membership voted to enable members to make an annual donation of 50 to BPNA Research Training Fellowships. If you wish to make this donation, please tick the box. I wish to make an annual donation of 50 to BPNA Research Fellowships GIFT AID boost your donation by 25%. Gift Aid is reclaimed by the BPNA from the tax you pay for the current tax year. Your home address is needed to identify you as a current UK taxpayer. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay the difference. Home Address 1:*Home Address 2:Home Address 3:Town/City:*County:Postcode:*Country:United Kingdom onlyPersonal Statement (Max 250 Words) Why would you like to join the BPNA? 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