MEMBERSHIP APPLICATION FORM All information is strictly confidential Name* DrMissMrMrsMsProf.Rev. Prefix First Last Business Name*Address* Street Address Address Line 2 City County ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Main phone number*Mobile Phone*Date of Birth* Date Format: DD slash MM slash YYYY Personal Email* Position held at present*Electrolysis Qualification:*Select qualificationFirst ChoiceSecond ChoiceThird ChoiceUnqualifiedWhen do you finish your training?* Date Format: DD slash MM slash YYYY Name of college/training provider*Date Qualified*It is a minimum requirement that you have 90 hours practical experience before taking the BIAE assessment. Date Format: DD slash MM slash YYYY Electrolysis/Epilation certificate(s)Which awards in Electrolysis/Epilation or relevant subjects do you have? (Attach your official epilation certificate(s) here.) Drop files here or Your chosen method of modality:* Galvanic Flash Blend Diathermy Brand of epilation machine*(Machine must be PAT tested and show in date)Please tell us how you heard about the BIAE*Recommended by another memberInternet searchSocial MediaDECLARATIONSInsurance* I am currently insured to practise ElectrolysisInsurance from* Date Format: MM slash DD slash YYYY Insurance to* Date Format: MM slash DD slash YYYY Attach a copy of your insurance certificate* Drop files here or Insurance claimsHave you ever had an insurance claim against you upheld concerning your standard of professional expertise or the health and safety of your staff or premises?YesNoInsurance claim details*Disability or learning difficulties*Please tell us about any physical disability or learning difficulties, (eg. Dyslexia) that you have.I have a physical disability or learning difficultiesI do not have a physical disability or learning difficultiesPhysical disability or learning difficulties details*Confirmation* The evidence that I have submitted is a true and honest account of my professional experience as an electrolysist.I apply for admission to the British Institute & Association of Electrolysis (BIAE) and undertake, if so admitted, and so long as I remain a member of the BIAE, to observe and abide by the rules and regulations of the BIAE for the time being in force and to endeavour to further its objects.Application Date* Date Format: DD slash MM slash YYYY Continual Professional DevelopmentAll professional health bodies require their members to update and expand their knowledge and skills to give the best to their clients. CPD is compulsory under Voluntary Self-Regulation and in support of this the BIAE requires its members to complete 10 CPD points per year for practitioner levels of membership. In applying for membership of the BIAE members are agreeing to abide by the contents of this code and any amendments that may be made in the future. Failure to do so may result in termination of membership. Application Form must be completed and returned 8 weeks in advance of the date of entrance to the British Institute & Association of Electrolysis and is by assessment only. Confirmation of the date of the next assessment will be advised upon receipt of an application.Product NameFee Options* ASSESSMENT RE-ASSESSMENT BOOSTER TRAINING SESSIONS PAST ASSESSMENT PAPER This fee is non-refundable. All assessment packages inclusive of BIAE Revision Manual. Annual membership not included - fee payable on a pro rata basis at time of joining. Option to pay membership by monthly Direct Debit instalments available. By completing this form you confirm that you wish to take the BIAE Assessment. Total £ 0.00 PhoneThis field is for validation purposes and should be left unchanged.