Application to Transfer from PACFA Registration

toIndividual PACFA Membership

This form isforcurrent members of PACFA Member Associations who are listed on the PACFA Register and who wish to transfer to individual PACFA membership. Completion of this form by a current PACFA Registrant ensures continuity of registration. Transferring Registrants do not have to complete a new application in order to join PACFA as an individual member.

Individual PACFA membership for practising members automatically includes PACFA registration at the relevant registration level (Clinical, Provisional or Intern).

PART 1: Personal Details

Your personal details will be treated as private and confidential
Family Name: / Title:
Given Names:
Postal Address:
Phone:
Email:
PACFA Member Association:
Level of PACFA Registration: / (Clinical, Provisional or Intern)

PART 2: College membership

Individual PACFA membership includes membership of theBranch in your State or Territory. From 1 July 2016, there will be Branches established in NSW, Victoria, Western Australia, Tasmania and the ACT. Further Branches will be established in other States in the future.

Individual PACFA membership includes membership of one PACFA College. In 2016, four Colleges will be established and others may also be established in the future. Please select one College you would like to join.

Australian College of Counsellors / Yes
Australian College of Psychotherapy – Somatic Psychotherapy Modality / Yes
Australian College of Relationship Counsellors and Therapists / Yes
Australian College of Counselling and Psychotherapy Education / Yes / o

If you would like to join more than one College, you will be able to do this from 1 July 2016 for the additional fee of $85 (inc. GST).

PART 2: Declaration

  1. I am a current PACFA Registrant.
/ Yes
  1. I understand that, as an individual PACFA member, my registration is automatically included with my membership. I continue to have all the same responsibilities and obligations that I have as a PACFA Registrant.
/ Yes

Date://20 Applicant’s Signature:

PART 3: Fee and Payment Options:

Administrative Fee:

There is a one-off administrative fee of $55 (inc. GST) to transfer from PACFA registration to individual PACFA membership.

Membership fees:

The first year’s membership feeis payable at the time of applying to transfer to individual PACFA membership. There is a pro-rata fee for 6 months for transfer applications received between October and March.

Please include payment of the administration fee plus the current membership fee applicable to your level of membership.

To view the current Membership fee please click here

Payment Options:

Cheques:Payable to PACFA

Direct Deposit: Bank: ANZ Lygon St

Account name: PACFA

BSB number: 013-259

Account number: 4919-78993

When paying by direct deposit, please quote your Surname and “Registration Transfer”

Please send your completed application form and relevant documents to PACFA via email or via post to 290 Park Street, Fitzroy North VIC 3068.

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