A p p l i c a t i o n t o j o i n t h e C M AYES, I would like to join the Complementary Medical Association

Title Forenames:

Surname:

Male/Female: Date of Birth:

Home Address:

Post Code: Telephone No.

Email address:

Practice Address:(if different from above)

Post Code: Telephone No.

Email Address:(if different from above)

Discipline(s):

I qualified in/Will qualify in:

Examining Bodies:

Membership of other professional bodies:

Additional qualifications:

I confirm that all the information given above is correct and authorise the CMA to make the necessary reference checks in connection with my application. Please sign, date and return this form, along with your cheque to The Complementary Medical Association, Roberta MacMillan, Blackcleuch,Teviothead, Hawick, Scottish Borders, TD9 0PU.Email: info@the-cma.org.uk Web site: www.the-cma.org.uk

Signature: Date:

Due to the amount ofmedia coverage that theCMA receives, we areconstantly being asked toprovide details of qualifiedpractitioners. If you wouldlike to benefit from this,please tick here for moredetails of our ReferralsScheme.

The CMA offers a highlycompetitive insurance ratewhich has been tailored specially to meet the needs ofCMA members. If you wouldlike to know more, pleasetick here:

Please enclose the followingdocuments in support of yourapplication.MCMA: A copy of your certificate/s, a copy of anypublished papers, insurancecertificate (if not insured by the CMA), 2 telephone numbers of referees or 2 written references*, relevantCV (optional), your cheque, and3 passport photos if you requirean ID card (name printed onreverse).CMA Affiliate: As for MCMAbut omitting certificates. Pleasealso enclose details of your proposer, seconder and cheque.CMA Associate: As for MCMA.CMA (Student): Insurance certificate (if applicable), 2references* from your place ofstudy, copy of any syllabus youare studying, cheque, and 3passport photos if you requirean ID card (name printed onreverse).Friend of the CMA: Pleasedetail your interest in complementary medicine andenclose your donation.

Data Protection Act 1984:I/We agree that the informationprovided on this form or duringany telephone call, may be held oncomputer and used for customeradministration, research and analysis purposes and marketingof financial and related products.The information may be disclosedto third parties whose productsmay be of interest to me and whomay hold it on computer for theabove purposes. If you prefer notto take part in research or receiveinformation about products andservices that we offer directly orare offered by third parties, pleasetick this box:

*You can send either written referencesor telephone numbers for 2 refereeswhichever is the most convenient.

I am applying for: (please tick relevant box)

MCMA £150 CMA (Affiliate) £150

CMA (Associate) £100 Friend of the CMA*

CMA (Student) £50 *I wish to donate £To help promote the interestsof complementary medicine.

Do you qualify for Membership?Membership comes in four grades and is open only to professionally qualified Complementary (or Conventional)

medical practitioners and students. The four membership levels are:

• Full Member • Affiliate Member • Associate Member • Student Member

There is a fifth category of membership - Friends of the CMA. See below for details.In order to qualify for any of these levels of membership, you must meet the following criteria:

FULL MEMBERS

Annual Fee £150A minimum of two years medical (Complementary or Conventional) experience anda qualification through a CMA recognised college. Members will receive a MemberCertificate (renewable each year), an ID card, the CMA Newsletter, preferentialadmission rates for seminars and talks, competitive insurance rates, discounts offmedical equipment etc, preferential bookings for seminars and an oportunity to jointhe CMA referrals scheme. Full members are entitled to use the initials “MCMA”.

AFFILIATE MEMBERS

Annual Fee £150Open to Senior Practitioners who do not hold a formal qualification, but who haveextensive experience and an established practice which has run for more than 5 years.Senior practitioners with complementary medical experience but no recognised medical qualifications may join after an interview by the selection committee. In addition, they will need to be proposed and seconded by two existing members of theCMA. Affiliate Members will receive an Affiliate Member Certificate (renewable eachyear), an ID Card, the CMA Newsletter, preferential admission rates for seminars andtalks, competitive insurance rates, discounts off medical equipment etc, preferentialbookings for seminars and an opportunity to join the CMA referrals scheme. Affiliatemembers are entitled to use “CMA Affiliate Member”.

ASSOCIATE MEMBERS

Annual Fee £100Open to recently qualified practitioners from CMA recognised colleges(Complementary and Conventional). Associate members will receive an AssociateMember Certificate (renewable each year), an ID Card, the CMA Newsletter,preferential admission rates for seminars and talks, competitive insurance rates,discounts off medical equipment etc, preferential booking for seminars and an opportunity to join the CMA referrals scheme. Associate members are entitled to use“CMA Associate Member”.

STUDENT MEMBERS

Annual Fee £50Open to students at CMA recognised colleges (Complementary and Conventional).Student members will receive a Student Member Certificate (renewable each year), anID Card, the CMA Newsletter, preferential admission rates for seminars and talks,competitive insurance rates, discounts on medical equipment etc, and preferentialbookings for seminars. Student members are entitled to use “CMA Student Member”.

FRIENDS OF THE CMA

Donation of £25 (or more)This category is open to anyone who wishes to ensure the success of the CMA and thecontinuance of our promotion of complementary medicine to a wider audience. Thismembership will be awarded in recognition of donations of £25 or more to theAssociation. You will receive the CMA Newsletter and will be able to attend seminars,talks, etc at reduced prices.

“It will only take a few minutes of your time to complete the short application form. Send it rightaway and I’ll ensure it receives immediate attention. I look forward to hearing from you”.

Roberta MacMillan, Membership Coordinator.