Iarta/Eata Membership: Application Form Please submit this form in order to join IARTA and/or complete your EATA Membership Renewal for 2012. For those who pay EATA Membership fees through another organisation and do not wish IARTA to collect their EATA Membership Renewal fees please also complete this form and tell us where you hold your EATA Membership. For information regarding EATA Membership via IARTA see our FAQ or for help completing this form please contact thilisa.hamilton@relationalta.com
First Name*
Last Name*
Email*
Address1*
Address2
City*
County/State*
Post Code/Zip*
Country*
Phone*
Mobile
Main Modality eg TA, Integrative*
Main Application eg Psychotherapy, Organisational*
Do you allow us to send you email and post your name, modality and country on our website?*	Please select... Yes No
Are you an existing Iarta Member?*	Please select... Yes No
If you pay 2012 EATA membership fees through another organisation, please name it here:
To which Code of Ethics do you subscribe?*
If you wish to hold your EATA membership via IARTA please select your membership category:	Please select... 1n - Associate Member (interested in TA) -- new to EATA - £0 1p - Associate Member (interested in TA) - previously EATA member - £0 2 - Regular Member (Student who has completed TA101) - £10 3 - Regular Member Trainee (Holds EATA Training Contract) - £38 4 - Certified Transactional Analyst (CTA) - £38 5 - Provisional Teaching and Supervising Transactional Analyst (PTSTA) - £110 6 - Teaching and Supervising Transactional Analyst (TSTA) - £110
Human Test: 9-3=*
* - Required field