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Date
..
Name:
Address:
Post Code:
.
Tel:
.....................Fax:
............
Email ...................................................................................................................
Date of Birth:
.
Current Certificate Held:
Date of first SDS Examination:
.
Present Teacher's Name:
..
(if applicable)
Membership Category:
(Delete where not applicable)
Student Member / Associate Member / Teaching Member / Non
Active Teacher
Teachers Only:
Would you like to register this year? Yes
/ No
Provisional Registration / Full Registration
/ Post Registration (Delete where not applicable)
Signature:.......................................................................................
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