Membership * = mandatory fields Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Civility *Ms.Mr.Contact *First nameLast nameGender *malefemaleBirth date (dd/mm/yyyy) *Nationality * Work addressNumber & streetPostcodeCityCountryPhoneEmail (= your login / Site display not required) *Personal addressNumber & streetPostcodeCityCountryPhoneEmail (also used as a backup & not displayed on the site) * Bachelor degree in PsychologyTitle of degreeDegree-awarding bodyIssuing countryUpload bachelor degree Click or drag a file to this area to upload. (Format PDF - Max 2MB)Academic transcript if bachelor without ECTS Click or drag a file to this area to upload. (Format PDF - Max 2MB)Master degree in PsychologyTitle of degreeDegree-awarding bodyIssuing countryUpload master degree Click or drag a file to this area to upload. (Format PDF - Max 2MB)Academic transcript if master without ECTS Click or drag a file to this area to upload. (Format PDF - Max 2MB) Doctorate degree in PsychologyTitle of degreeDegree-awarding bodyIssuing countryUpload doctorate degree Click or drag a file to this area to upload. (Format PDF - Max 2MB)Psychotherapy trainingTitle of degreeDegree-awarding bodyIssuing countryUpload psychotherapy certificate Click or drag a file to this area to upload. (Format PDF - Max 2MB) Upload additional documentsMESR registration (Registre des titres) * Click or drag a file to this area to upload. (Format PDF - Max 2MB)Apply exception Benelux and Baltic countriesCheck Ethics Pledge * Click or drag a file to this area to upload. (Format PDF - Max 2MB)Authorisation to practise as psychotherapist by Ministry of Health * Click or drag a file to this area to upload. (Format PDF - Max 2MB)I am not a psychotherapistCheckCommentsRemarkenRGPD *I consent to this website storing the information I have provided in order to respond to my request.* = mandatory fieldsSubmit
