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Professionals Registration
Professionals Registration
This application form is applicable for individuals who are fully qualified or practicing independently as an MFT or Systemic Family Therapist or related mental health profession. Proof of qualification must be submitted along with completed application.
Member Information
* First Name
* Last Name
*
Gender
Male
Female
Phone Number
Date of Birth
Physical Address
National ID/Passport/Alien ID/ Maisha Card number:
Primary Work Setting (e.g. hospital, school, private practice etc.):
Country of Practice
Upload Documents
*
University Degree (PDF, DOC, DOCX)
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use mouse scroller for zoom image.)
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Drop file here or click to select.
Max Size 5MB
*
National Identity (PDF)
Drop file here or click to select.
Max Size 5Mb
Statement of Professional Ethics and Conduct
Have you ever been convicted of a felony or of any misdemeanor which might relate to your qualifications or functions as a therapist or other professional; or have you ever had your registration, certification or license to practice in the healthcare industry suspended, revoked, restricted or denied; or has any other disciplinary action been taken against you by any federal, state, or provincial regulatory body or foreign jurisdiction; or are you presently under investigation by any regulatory body to the best of your knowledge? (if your answer is ‘yes’ to this question, please send us an email on info@sftak.org with detailed information)
No
Yes
Special Interest Groups
Select one or more of the SFTAK Special Interest Groups:
Community Mental Health
Relational Health & Trauma
Spirituality
Grief
Member Credentials
Please indicate the degree which you would like to have listed in your SFTAK membership record. This should be the degree that qualifies you to practice independently as an MFT. The degree you choose will appear in all correspondences and in SFTAK’s online Membership Directory.
Degree
University from which your degree was obtained
Would you like to be listed in our online Membership Directory?
Yes
No
Account Login Setup
* Email Address
* Password
Strength: Very Weak
* Confirm Password
Professionals Registration
5,100.00
KSh
Select Your Payment Gateway
Bank Transfer
SFTAK Paybill Number: 4130353, Account number: your name
Bank: Stanbic Bank Kenya
Account Name: Systemic Family Therapy Association of Kenya
Account number;
Kes: 0100012774146
Usd: 0100012774178
Swift Code: SBICKENX
Bank Code: 31000
Branch Code: 1019
Branch: Buruburu
Transaction ID
Transaction ID
Please enter Transaction ID.
Bank Name
Bank Name
Please enter Bank Name.
Account Holder Name
Account Holder Name
Please enter Account Holder Name.
Additional Info/Note
Additional Info/Note
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* First Name
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* Email Address
* Password
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