Please complete in BLOCK CAPITALSin black ink

Please retain a copy of yourapplication and supporting documents for your records

GROUP LEADER OR FACILITATOR- MEMBER APPLICATION
Section 1A: Contact Details (PLEASE PRINT CLEARLY)
Title
First Name
Last Name
Address
Town/City
County / Post Code:
Tel: (home) / Mobile:
Email Address
Web Site
Section 1B: Fees and Registration / X
Fee: Basic 12 month membership - £39.99
OPTION A: pay online by transferto TSA (REF: LAST NAME AND INITIAL)
Bank Details – Barclays A/c No: 73994147 Sort Code: 20-72-17
OPTION B: pay by PayPal
For TSA Admin use
Date received: ______
Amount received: £ ______/ Date of Registration: ______
Registration No. : ______
Section 1C: Qualifications and Proof of ID:
Please include the following COPY DOCUMENTS with your application / X
  • Copies of qualification certificate(s) for therapies listed

  • A copy of current basic first aid certificate (or copy of receipt for course booking)

  • A copy of photo ID (e.g. passport or DVLA photo license)

Section 1D: Insurance
Please include the following relevant COPY DOCUMENTS with your application
  • A copy of current relevant insurance certificate(s) – practitioner/public liability/product liability

  • Indicate that you are applying through the TSA block scheme for insurance – please send copy of certificate when you have obtained insurance cover.

Failure to send documents will result in your application being delayed

Section 2A: Education and Training
(Please use BLOCK CAPITALS to complete this section)
Training History: / Please list all sound therapy qualifications you wish to register. You may be required to give further details if the school you trained with is not a member of the TSA. If you do not have a qualification but have developed your own method, please complete the associate member form.
Therapy 1
Therapy 2
Therapy 3
Section 2B: Training History
Therapy Name
School/College
Address
Telephone
Date Attended / Course Length
Certificate Award
Therapy Name
School/College
Address
Telephone
Date Attended / Course Length
Certificate Award
Therapy Name
School/College
Address
Telephone
Date Attended / Course Length
Certificate Award
Section 3A: As a group leader / facilitator TSA best practice guidelines are as follows
First Aid / You are required to have a current First Aid qualification
Accident book / Check if the venue has an accident book and First Aid kit or you can carry one yourself. Any accidents must be noted.
Insurance / You are required to have public liability insurance for holding groups / workshops / events.
We recommend you check whether the premises you are using has current public liability insurance in the event of an accident.
Vulnerable people / If you are working with children or vulnerable individuals please make sure you have the relevant CRB checks in place, and include a copy with your application.
Contra Indications / When working therapeutically with the intention of positively affecting health and wellbeing, these must be stated on literature advertising the event and also be checked with attendees.
Section 3B: Declarations – Character & Health / X
Have there ever been disciplinary findings made against you, conditions imposed upon your practice by another regulatory or professional body or have you ever been party to civil proceedings relating to your professional practice?
Do you have any health condition that would affect your ability to practice?

NB: If you have indicated any of the above declarations, please provide details on a separate sheet

Section 3C: Character Reference
The following person is known to me in a professional capacity and has agreed to provide a good character reference on my behalf should the TSA wish to contact him/her:
Name:
Address:
Telephone:
Email
Section 4: Acceptance of TSA Membership Terms & Conditions / X
I declare that I have read, understood and will comply with the TSA Professional Standards and Code of Ethics
I declare that I have read, understood and will comply with the TSA Continuing Professional Development (CPD) requirements
I declare that I have enclosed fee payment or agreed to pay online
I agree to pay my renewal fee for registration 14 days prior to the annual renewal due date
(A reminder email will be sent to you 1 month in advance)
Signature / Date: _ _/_ _/_ _ _ _

Therapeutic Sound AssociationCo No: 7544626