Online Application Form
Type of membership :
Full MembershipAssociate Membership
Name of National Association of Physical Therapy:
Name of Chairperson / President of National Association of Physical Therapy:
Name of National Cardiorespiratory Physical Therapy special interest group/section/division:
Name of Chairperson / President of National Cardiorespiratory Physical Therapy special interest group/section/division:
Email address of National Cardiorespiratory Physical Therapy special interest group/section/division:
Postal Address of National Cardiorespiratory Physical Therapy special interest group/section/division:
Name of contact person for ICCrPT
Email address of contact person for ICCrPT
Is your Organisation recognised by your National Association of Physical Therapy as a special interest group/section/division?
For how long has your National Organisation in Cardiorespiratory Physical Therapy existed?
How many members do you have this year?
What are the criteria to become a member?
Do you charge money for this membership?
How much do you charge per year for this?
s your Organisation recognised by your National Government and by other Organisations in Cardiorespiratory health care, or Universities?
If yes, by whom?
Is there a post-graduate course in Cardiorespiratory Physical Therapy in your country?
If yes, how long does the post-graduate course take to complete?
Does it lead to an academic degree?
If yes, what degree does it lead to?
Where is the post-graduate course held?
(You may enter more than one university)
Is the study method part-time or full-time?
Does the post-graduate course include a practical training period?
If yes, how many hours?
Do you need to have some years of working experience as a physiotherapist in general or in this area, before you can start the post-graduate course?
If yes, how many years in general?
And how many years in the area of Cardiorespiratory Physical Therapy?
I hereby authorise that the applying organisation has taken cognisance of the existing membership conditions and the procedure for paying membership fee.
Name of the Chairperson / President of the applying organisation:
Date of application:
Security Question: What day comes after Monday: