Listing of Satir Practitioners Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0><script type="text/javascript" src="http://hb.lycos.com/hb.js"></script> <script type="text/javascript" src="http://ratings.lycos.com/ratings/lycosRating.js.php"></script> <script type="text/javascript"><![CDATA[//><!]]></script> <script type="text/javascript" src="http://scripts.lycos.com/catman/init.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-start.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-middle.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-end.js"></script> <noscript> <img src="http://members.tripod.com/adm/img/common/ot_noscript.gif?rand=554232" alt="" width="1" height="1" />  <iframe frameborder="0" marginwidth="0" marginheight="0" scrolling="no" width="728" height="90" src="http://ad.yieldmanager.com/st?ad_type=iframe&ad_size=728x90&section=209094"></iframe>  </noscript> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=168 BGCOLOR="#000000" TEXT="#F7F7FF" background="002a11c3.gif"> <bR> </td> <td valign="top" BGCOLOR="#000000" TEXT="#F7F7FF"> <div> <I><B>Listing of Satir Practitioners Form</b></I></div> <div> <FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT><B>Back to:</b><A HREF="id8.htm" TARGET="_top" TITLE="Satir Practitioners"><U><B> </b></U></A><FONT SIZE="1" COLOR="#0000FF" FACE="Arial" ><A HREF="id8.htm" TARGET="_top" TITLE="Satir Practitioners"><U><B><U>'Satir Practitioners' Main Page</U></b></U></A></FONT></div> <div> <IMG SRC="001f4010.gif" border=0 width="500" height="1" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>You will be listed only if you have a formal qualification, through successful completion of a clinical examination to practise as a Satir Practitioner, in a Satir Training Programme. </b></div> <bR> <div> <B>For our file information:</b></div> <bR> <div> Name: (Mr/Ms/Dr)_________________________________________________</div> <bR> <div> Tel: (H) ________________ (O) _______________ </div> <bR> <div> H/P: __________________</div> <bR> <div> Pager: _________________ E-Mail: _______________________</div> <bR> <div> Address: </div> <div> _________________________________________________________</div> <div> _________________________________________________________</div> <div> _________________________________________________________</div> <bR> <div> Current Employer: </div> <div> ___________________________________________________________</div> <bR> <div> Address: </div> <div> ___________________________________________________________</div> <div> ___________________________________________________________<FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT></div> <bR> <div> Current Occupation/Position: </div> <div> _____________________________________________________</div> <bR> <bR> <div> <B>For our website publication:</b></div> <bR> <div> How do you want your name, titles / qualifications to be listed ? (Please submit certificates to show proof of titles / qualifications obtained)</div> <div> ______________________________________________________________________</div> <bR> <div> How do readers contact you ?</div> <bR> <div> E-mail: _________________</div> <bR> <div> Other Contacts: ____________________________________</div> <bR> <div> Your location: ___________________________________________</div> <bR> <bR> <div> By signing this application form, I confirm that I have furnished Satir Centre - Singapore with accurate information pertaining to my titles / qualifications obtained, and that I am also agreeable to have my name and titles / qualifications listed on the web. I also agree to keep the Satir Centre - Singapore informed of any change to my current personal, educational and employment status by re-submitting a fresh application form when necessary.</div> <bR> <bR> <bR> <bR> <div> __________________                                _________<FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT></div> <div> Signature of Applicant                                        Date</div> <bR> <div> All completed application forms must be enclosed with photocopies of relevant titles / qualifications obtained to be mailed to:</div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> Satir Cenrtre - Singapore<FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT></div> <div> Telok Blangah East Post Office<FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT></div> <div> P.O. Box 137<FONT SIZE="3" COLOR="#FFFFCC" FACE="Arial" > </FONT></div> <div> Singapore 910902</div> <bR> </td> </tr></table></body>