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Apply for Registration Page 1 of 5   Welcome to Psychotherapists Board of Aotearoa New Zealand's online registration process. At the completion of your online registration you will be given a link. This link will take you to a registration information form, registration checklist and templates. You are required to send your completed registration checklist and templates to the Board as part of your registration application. The information contained in this link can also be found on the Psychotherapists Board of Aotearoa New Zealand website www.pbanz.org.nz/index.php?Forms   Your full name. Preferred title: Mr Mrs Ms Miss Dr First name: Middle name(s): Last name: Gender: Male Female Date of birth: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Month January February March April May June July August September October November December   Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 When we contact you, we will use the name you prefer to be called (eg "Jacq" instead of "Jacquelyn"). Name you wish to be called by: You will be able to log into the PBANZ website using your email address and a password of your own choosing. Email is the primary means of communication by the Board to you. It is important that your email address is correct and kept up to date (and is not an email you share with another Psychotherapist). Email: Password: Confirm password: To prevent spam and this page being used by automated programmes, please enter the letters and numbers that appear below into the field below it.     Note: If your uncompleted application is older than 6 months it will automatically be deleted. If this happens, you will be required to complete a new application.

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