The Western Cape Association for Play Therapy


 
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WESTERN CAPE ASSOCIATION FOR PLAY THERAPY
WES-KAAPSE VERENIGING VIR SPELTERAPIE

APPLICATION FORM: MEMBERSHIP
AANSOEKVORM: LIDMAATSKAP

Annual Subscription / Jaarlikse Fooi: R 200.00

Complete the electronic application form and send it to us electronically by clicking on the Send button
or
complete the application form (electronically or by hand) and fax a printout to +27 86 531 0309 or send it via e-mail.

Vul die elektroniese aansoekvorm in en stuur dit aan ons deur op die Stuur knoppie te kliek
of
vul die aansoekvorm in (elektronies of met die hand) en faks 'n uitdruk na +27 86 531 0309 of stuur dit via e-pos.

Title/Titel:
Naam/Name:
Surname/Van:
Address/Adres:
Postal code/ Poskode:
Telephone/Telefoon: (w)  (h)  (cell/sel) 
Fax/Faks:
E-mail/E-pos:
Occupation/Beroep:
Institution/Instelling:
Date/Datum:
Signature/Handtekening
(when faxed/wanneer
gefaks word)
   
 
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