Information Request - Republic of Ireland Residents

This form is for counsellors, psychotherapists and psychologists who live in the Republic of Ireland and wish to receive information about membership of the Psychologists Protection Society.

You can request an information pack to be sent to you by POST. This can be sent today or closer to your insurance renewal date. You can also request a telephone CALL BACK. We can telephone you ASAP or closer to your insurance renewal date.

  1. I would like to receive more information about joining PPS (*)
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  2. How did you hear about PPS?(*)
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  3. Title(*)
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  4. First Name(s)(*)
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  5. Surname(*)
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  6. Full Postal Address
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    (complete for information by POST - please include full address details)
  7. Telephone Number (complete for a CALL BACK)
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  8. Email (complete for information by EMAIL)
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  9. I would like more information about joining PPS
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  10. If at a later date, when would you like to be contacted
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  11. Other information
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    Please provide details of any other information you feel we need to know