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PROVISIONAL APPLICATION FORM FOR MEMBERSHIP OF THE BBEC
 
First name:                                         Surname:                                          Date of Birth:
Address :
 
 
 
Postal Code:
E-mail address:
Telephone:                                                     Mobile:
Brief details of your Buteyko training/background:
 
 
 
 
 
 
 
 
 
Number of years in practice:
Approximate number of clients trained:
 
I hereby apply for provisional membership of the BBEC Register and accept that final approval  of my membership will be the responsibility of the elected BBEC council members.
I enclose a cheque for £75 (£100 after 1/9/2014) made payable to "BBEC Ltd" as payment for membership fee for the first year or I shall pay by BACS (Bank A/C detail: Co-operative Bank, PO Box 250, Delf House, Southway,
Skelmersdale. WN8 6WT BBEC Ltd. Sort Code: 08-92-99 A/C No. 65557307)
If for whatever reason the membership committee does not accept my application I understand that I will receive a refund of £50.
 
Signed:                                              Date:
 

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