Name of practice Address Address Line 1: Address Line 2: Town: Postcode: Telephone number E-mail address Website If you need to list more than one practice, please use the Supplementary Practice Form and return this along with the completed Registration form. Section 3 - Contact Details You must supply us with one contact address, phone number and e-mail for the purposes of verification and to allow us to communicate with you. However, unless you choose to use your practice information for this (and therefore repeat that listed above), it will not be made public. Email address Telephone number Address Address Line 1: Address Line 2 Town: Postcode: The FMC (including FMSB) will use these details to send you information about registration, accreditation and standards. If you would also like to receive newsletters and other updates about the FMC and FMSB’s work, please select this box: Section 4 - Declaration I certify that I am working towards FMCA in accordance with the FMC Manual of Professional Standards and Self-Regulatory Framework. I certify that the information I have provided on this form is correct. I consent to this data being captured and stored electronically or otherwise by and on behalf of The Family Mediation Council in accordance with the provisions of the Data Protection Act 1998. Please complete as appropriate:
Name of practice Address Address Line 1: Address Line 2: Town: Postcode: Telephone number E-mail address Website If you need to list more than one practice, please use the Supplementary Practice Form and return this along with the completed Registration form. Section 3 - Contact Details You must supply us with one contact address, phone number and e-mail for the purposes of verification and to allow us to communicate with you. However, unless you choose to use your practice information for this (and therefore repeat that listed above), it will not be made public. Email address Telephone number Address Address Line 1: Address Line 2 Town: Postcode: The FMC (including FMSB) will use these details to send you information about registration, accreditation and standards. If you would also like to receive newsletters and other updates about the FMC and FMSB’s work, please select this box: Section 4 - Declaration I certify that I am working towards FMCA in accordance with the FMC Manual of Professional Standards and Self-Regulatory Framework. I certify that the information I have provided on this form is correct. I consent to this data being captured and stored electronically or otherwise by and on behalf of The Family Mediation Council in accordance with the provisions of the Data Protection Act 1998. Please complete as appropriate:
2018-FMC-Registration-form-Working-Towards-Accreditation.docx