• Membership Application for

    the Association of Somatic and

    Integrative Sexologists (ASIS)

  • Instructions

    • Please read the Code of Ethics and Ethical Codes of Practice before completing the form.
    • Please note that ALL Associate and Professional applicants must provide two referees who will be contacted by ASIS.
    • All information given is confidential.
    • This is an online form. It needs to be completed in one sitting at your computer, therefore we strongly recommend you have the following information to hand before starting the form:
      • Business Details
      • Information about ASIS Recognised Professional Training
      • Information about other Professional Training
      • Information about Continuous Professional Development Training
      • Information about Personal Development Courses
      • Names and Websites of professional bodies you are registered with
      • Details about your professional supervision
      • Details of two referees
      • List of therapies you wish covered by insurance
      • Copies of training certificates and supporting documents to hand
    •  * indicates a requires field
    • The membership application form needs to be completed in full by the applicant and submitted online, along with scanned copies of the applicant’s signature and all relevant supporting documentation.
    • When you submit the application form, you also need to make payment - full details are given in Section 9.
    • PLEASE NOTE THAT NO APPLICATIONS WILL BE CONSIDERED WITHOUT FULL PAYMENT (see section 9).  IF, FOR ANY REASON, YOUR APPLICATION IS TURNED DOWN, YOUR PAYMENT WILL BE RETURNED, MINUS THE £10 PROCESSING FEE
    • Any applicant with a history of mental health problems must inform the registrar on application.
    • This form can be completed on a PC/Mac and Tablets only. Please note - do not try and complete this form on a mobile phone as some elements will not function correctly.
  • CONTENTS:

    Section 1 - Membership category
    Section 2 - Personal details
    Section 3 - ASIS recognised professional certifications
    Section 4 - Other professional training
    Section 5 - Professional supervision & peer support
    Section 6 - Disclosure
    Section 7 - Applicant's declaration and signature
    Section 8 - Applicant's references
    Section 9 - Membership fees & payment
    Section 10 - Insurance
    Section 11 - Documentation check list

  • Section 1: Membership Category

    If you are unsure about which category to apply for, please reread Membership Categories.

  • Section 2: Personal Details


  •  -  - Pick a Date
  • Business Details


  • Section 3: Other Professional Training

  • List relevant Professional Training

    • Somatic Sexology (e.g. Certified Sexological Bodywork / Psychosexual Somatics® Therapy / Sexual Surrogacy / Tantra Massage)
    • Bodywork (e.g. lomi lomi / myofascial bodywork / remedial massage / Swedish massage / Thai massage / trigger point)
    • Energy work (e.g. Bach flowers / breathwork / homeopathy / polarity therapy / reflexology / Reiki / Shiatsu / vortex)
    • Movement practices (e.g. chi kung/qi gong, five rhythms/dance, yoga)
    • Sexology (e.g. clinical sexology / sex coaching / sex education / sex therapy)
    • Talk-based disciplines (e.g. coaching / counselling / psychotherapy / psycho-sexual therapy)
    • Teaching / facilitator trainings
    • Transpersonal work (e.g. Buddhist / Quodoushka / shamanic / Tantra / Taoist teachings)
  • Continuous Professional Development (CPD)

  • Section 4: Professional Supervision & Peer Support

  • Peer Support

  • Joining a peer support group ("ASIS Circle”) is mandatory for all members.

  • Section 5: Disclosure

    • This section must be fully completed.
    • Please note that disclosure of any information does not automatically exclude you from ASIS membership. However, failure to disclose such information may result in a refusal or termination of membership.
  •   Yes No
    Do you have a conviction that is not spent under the Rehabilitation of Offenders Act 1974?
    Have you ever been refused / expelled from membership of any professional body / register on the grounds of professional misconduct?
    Have you ever been the subject of any other disciplinary action, investigation, proceeding or enquiry?
    Are you currently or likely to be the subject of any disciplinary action, investigation, proceeding or enquiry?
    Has your fitness to practice been impaired for any reason including health or personal circumstances?
    Have you ever had any psychiatric diagnosis or serious mental health problems?
    Are there any other factors that could call into question your suitability for membership?
    Have you ever had a serious complaint or claim made against you for any of the therapies you will be practising under your ASIS membership and for which you wish to be insured?
  • Section 6: Applicant's Declaration

    • Applicants must have read and understood ASIS Code of Ethics and Ethical Codes of Practice  
    • It is the responsibility of members to ensure their full understanding of the professional conduct procedure and associated protocols. You may wish to read the  ASIS Articles of Association .
     
  • Section 7: Applicant's References

  • For Professional and Associate Applications only

    • Every Professional and Associate membership application must be supported by two referees, whom ASIS will contact directly.

    Requirements for Referees

    1. The referees must not be the applicant's partner, relative nor a member of the ASIS committee.
    1. Professional reference: One referee must have known the applicant in a professional capacity and be either a trainer or supervisor.
    2. Character reference: One referee must have known the applicant for a minimum of two years and be a person who is professionally qualified.
    3. Referees may be required to state their profession and qualifications
  • Details of Referee 1 - to be completed by applicant:

  • Details of Referee 2 - to be completed by applicant:

  • Section 8: Membership Fees & Payment

  • Membership Costs

    Professional Membership: £65
    Associate Membership: £35
    Student Membership £15

    In addition all applications incur a one off £10 form processing fee.

    Payment to be made as a single payment by BACS to:

    The Association of Somatic and Integrative Sexologists,
    Bank:  Barclays
    Account number: 60092770
    Sort code: 20-95-61

    For international transfers:
    IBAN: GB04 BARC20956160092770
    SWIFT / BIC: BARCGB22

  • Please email payments@the-asis.org confirming the payment amount, the date of payment and the reference (please use your name) on the bank transfer

  • ASIS is a voluntary organisation and its set up costs have been met by founding members.
    There are a number of projects that can happen more quickly with more funds.

  • Section 9: Insurance

  • For Completion by Professional Membership Applicants Only

    Insurance is available to “Professional Members” who are resident in the UK, Ireland and most EU countries (Austria, Belgium, Channel Islands, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Iceland, Ireland, Isle of Man, Latvia, Liechtenstein, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, Sweden).

    It is operative World Wide (excluding the USA & Canada) and is particularly wide in scope. Please see a summary of the insurance by visiting the ASIS website.

    Please read these thoroughly to ensure it meets your insurance needs.  It includes third party premises, and £5m indemnity. 

    This insurance provides cover for you as an individual (or sole trader). The Third Party Liability cover does extend to include occasional assistants or helpers. Employer’s Liability is not included. (Employer`s Liability insurance may be required for helpers or assistants whether paid or unpaid)

    Insurance for Ltd & LLP businesses can be arranged on request.

    Once membership is approved, we will forward your application to the insurance company, who will contact you directly with a quotation for your insurance cover, which is paid to them directly.

    Estimates for insurance costs 2015-2016 are:

    Band 1: £98 per annum*

    Modalities covered include sex coaching; massage; reiki; bioenegetics; counselling and basic holistic/alternative therapies.

    Band 2: £180 per annum*

    Modalities covered include Certified Sexological Bodywork; Tantra Massage as well as all categories covered under Band 1 as long as practitioners are accepted as qualified for Professional Membership with this band by ASIS.

    Band 3: £320 per annum*

    Psychosexual Somatics® Therapy (PSST), sexual surrogacy, as well as all categories covered under Bands 1 and 2 as long as practitioners are accepted as qualified for Professional Membership with this band by ASIS.

    *IMPORTANT.  These are guideline prices. Each application is considered on its own merits and the insurers will provide a bespoke quotation once ASIS has approved your membership application.

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  • Data Protection Act

    ASIS is licensed under the Data Protection Act to hold the data you provide for purposes of maintaining your membership – as a service to you and condition of membership we will send you information about ASIS events, services and products that may be of professional interest. 

  • Section 10: Check-List

    Please scan / photograph and email a copy of your training certificates and any other supporting documents to membership@the-asis.org including in the subject line the unique id reference that you will receive on submission of this application form

  •   Yes No
    Training Certificates
    Other Supporting Evidence
    Payment Sent
  • Membership queries and payments

    If you have any queries regarding the application form please contact the ASIS Membership Secretary: membership@the-asis.org

    Please email payments@the-asis.org confirming the payment amount, the date of payment and the reference (please use your name) on the bank transfer.

    Please note that no applications wll be considered without full payment. If, for any reason, your application is turned down, your payment will be returned, minus the £10 processing fee.

     

  •  -  - Pick a Date
  • Please complete the security box below and then press the "Submit" button. The information you have provided will be sent to and reviewed by BGi.uk who will then confirm the cost of insurance to you.

  • Insurance arranged by BGi.uk    Email: yogaform@BGi.uk.com    Telephone: 01367 246157

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  • Bordengate Insurance and BGi.UK are trading styles of H J Roelofs (UK) Ltd which is authorised and regulated by the Financial Conduct Authority (FCA). Oour Financial Services register number is 307129. Company Registration no. 3464365

    Terms & conditions on www.bgi.uk.com and available on request.

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