Secure data processing for
Membership Renewal Application.
Fields marked with a '*' are mandatory
for a PDF file about Supervision Requirements.
Please give details of any specialities:
Fluent in any languages other than English:
Are you applying for upgrade of membership?
If 'Yes', to which grade?
Member - MNRPC
Accredited Member - MNRPC(acc.)
Existing Membership grade:
When did you qualify?
How many sessions monthly
- how many teaching hours monthly?
(or go to
if not in practice)
Type of Supervision:
Session frequency and length:
Face to Face
Other (please specify):
Please note: Supervision details are subject to a random checking procedure
(This is subject to randomised checks)
Check all appropriate boxes:
I want to renew my membership of both NRPC and APHP at £105.00.
I have not been in practice during the last 12 months and do not expect to be so in the coming year.
I have not been in practice during the last 12 months but expect to commence during the coming year.
I have professional indemnity insurance; my certificate number is:
I know of no legal or other reasons why my membership should not be renewed.
I have attended a minimum 15 hours CPD training in the last twelve months, as follows:
Please Note: CPD details are subject to a random checking procedure
I'll pay my subscription by:
Credit Card - details below
Credit Card - please contact me for details
Cheque to be posted to you within 7 days
I already pay by Bankers Standing Order
Bankers Standing Order - you'll send me a form
(This is a secure form):
Start date (mmyy):
Exp. date (mmyy):
Security number (last 3 digits on back of card - 000 if not paying by card):
This typed signature signifies that you confirm all details on this form are correct to the best of your knowledge. Where this name does not match that at the top of the form, the application will not be processed.
iNet-secure.co.uk is in association with EICH Ltd. Registered England No. 3911650