Membership Application

The QICPE Team is always delighted to encourage previous students and others to become financial members of the Queensland Institute of Clinical Pastoral Education.

If you would like to join, please complete the following form:

Member Title*
First Name*
Surname*
Address Line 1
Address Line 2
Address- Suburb/Town*
State*
Postcode*
Please enter a number from 0000 to 9999.
Mobile Telephone*
Email*
CPE Units completed - Year, Location, Supervisor (if known)
For New or Lapsed Members: Please provide a name and phone number of a current QICPE member to nominate you for membership.
Mandtory Declaration*
- As an ordinary member of QICPE Inc, I have read and will abide by the QICPE Inc Code of Ethics and Professional Practice for ordinary members of QICPE (QICPE Standard 9.6) as found at https://qicpe.com/curriculum/
- As a CPE Supervisor member of QICPE Inc, I have read and will abide by the QICPE Inc Code of Ethics and Professional Practice for Supervisory members (QICPE Standard 9.5) as found at https://qicpe.com/curriculum/
One Year Membership
Price: $30.00
$30 if paid by Direct Deposit or cheque. $31 if paid by credit card online.
Payment Method*
Please advise our Treasurer, Trish, of any payments via email: treasurer@qicpe.com
Name
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