Affiliate Membership Expression of Interest

Email Address:
Phone No.
Mobile No.
Home Address
National Insurance No.
Marital Status
Ethnic Origin
Expression of Interest
Counselling Qualification and Training Status
Current Clinical Supervision
BACP Member
Do you have access to the online DBS update service for a current and valid DBS certificate in your name, with a minimum of 1 year remaining
Do you have a Criminal record
Are you able to provide 2 current, or most recent, references from your Work Place, Tutor and or Clinical Supervisor
If no please give reasons

Using your personal information

Personal information which you supply to us may be used in a number of ways, for example:

  • We will use the information you give to help provide the services/products you have requested that we supply to you.
  • From time to time information may need to be accessed by our website and hosting providers to ensure the smooth running of the services we provide.
  • We will not disclose any information to any company outside the above mentioned scenarios except to help prevent fraud, or if required to do so by law

For further information on how your information is used, how we maintain the security of your information, and your rights to access information we hold on you, please visit