Listing of Satir Practitioners Form

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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.

For our file information:

Name: (Mr/Ms/Dr)_________________________________________________

Tel: (H) ________________ (O) _______________

H/P: __________________

Pager: _________________ E-Mail: _______________________

Address:

_________________________________________________________

_________________________________________________________

_________________________________________________________

Current Employer:

___________________________________________________________

Address:

___________________________________________________________

___________________________________________________________

Current Occupation/Position:

_____________________________________________________

For our website publication:

How do you want your name, titles / qualifications to be listed ? (Please submit certificates to show proof of titles / qualifications obtained)

______________________________________________________________________

How do readers contact you ?

E-mail: _________________

Other Contacts: ____________________________________

Your location: ___________________________________________

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.

__________________                                _________

Signature of Applicant                                        Date

All completed application forms must be enclosed with photocopies of relevant titles / qualifications obtained to be mailed to:

Satir Cenrtre - Singapore

Telok Blangah East Post Office

P.O. Box 137

Singapore 910902