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DEADLINE: 29 January 2010

This official PsySSA Directory of Psychologists in Private Practice is widely relied on for referrals countrywide. Invaluable referrals from the PsySSA office and various other agencies are made from this national Directory, which is the only dedicated Psychologists' Referral source in South Africa.

Kindly complete and submit this form (plus a cheque for R400.00 incl. VAT or make a direct deposit into PsySSA ABSA Bank Account number: 1630 1650 98 and fax the deposit slip to the PsySSA office) by 29 January 2010 if you want your details included in the forthcoming 2010 Directory. No late entries will be accepted!

Title		Name
Surname		Sex
Address
Region
Postal Code:
Work No.		Home No.
Cell Number		Fax Number
Email		HPCSA Number
Registration Category		Languages
Primary Therapeutic Approach		Preferred Client Age Group
Focus Area 1		Focus Area 2
Focus Area 3		Focus Area 4
Focus Area 5		Focus Area 6
Focus Area 7		Focus Area 8
Other

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