Student Membership

Part A: Personal Details

Title:

First Name(s):

Surname:

Date Of Application:

Email:

Telephone:

Full Address (including postcode):

Part B: Course/Programme Information

Training

Have you started in clinical practice:

If Yes, please complete a Trainee membership application form

Yes No

Terms and Conditions

UPCA Student Membership

In applying for UPCA Student Membership, I hereby agree to:

Abide by the UKCP Code of Ethics and Professional Practice
Advise UPCA of any breaks in training
Inform UPCA about any convictions or complaints made against me
Maintain membership of UPCA for the duration of my training
Notify UPCA when I begin clinical practice and apply for Trainee Membership
Notify UPCA of any change of contact details
Comply by the UPCA Fitness To Practice procedures

DECLARATION:

I declare that my application form contains only true information. I understand that UPCA may make enquiries as they consider necessary to verify any information given. I understand that if any incorrect, incomplete or plagiarised information is discovered, my application/renewal may be invalid and UPCA has the right to withdraw my application. I understand that my membership of UPCA (and any associated UKCP membership) is dependent upon remaining in membership of UPCA.

MEMBER SIGNATURE / E-SIGNATURE

DATE

Data Protection

The information you provide in this form is required to process your membership. You will have the right to access the information you have provided as well as the other rights afforded to you under data protection laws. You may request for the information to be destroyed. This will result in your withdrawal from the process. If you do not provide all the information required on this form your renewal may not be processed. Information submitted may be stored and processed electronically for the purposes of delivering services, marketing and supplying information. Data may be passed to other parts of the organisation and partner organisations operating on our behalf to enable this to take place. We will ensure your data is always stored and handled securely. To find out more about the way we look after personal data please see the UPCA privacy notice at www.upca.org.uk

💰 Choose Your Payment Method

Student Membership Fee: GBP 21.00

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