Online Application Form

Online Application Form

Type of membership :
Full MembershipAssociate Membership

Country:

Name of National Association of Physical Therapy:

Name of Chairperson / President

Name of National Cardiorespiratory Physical Therapy special interest group/section/division:

Name of Chairperson / President

Email address

Postal Address

Telephone number

Fax number

Website

Name of contact person for ICCrPT

Email address

Postal Address

Telephone number

Fax number

Supporting information

Is your Organisation recognised by your National Association of Physical Therapy as a special interest group/section/division?
YesNo

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?
YesNo

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?
YesNo

If yes, by whom?

Is there a post-graduate course in Cardiorespiratory Physical Therapy in your country?

YesNo

If yes, how long does the post-graduate course take to complete?

Does it lead to an academic degree?
YesNo

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?
YesNo

Does the post-graduate course include a practical training period?
YesNo

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?
YesNo

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.
Yes

Name of the Chairperson / President of the applying organisation:

Date of application:

Security Question: What day comes after Monday: