WESTERN CAPE ASSOCIATION FOR PLAY THERAPY WES-KAAP VERENIGING VIR SPELTERAPIE APPLICATION FORM DAY VISITOR ANNUAL MEMBERSHIP Name Surname Work number Cell phone number Work email Personal email Occupation Organisation Area(s) of service rendering Please turn the page and circle your answers If registered, which council? Registration number Do you work privately? [Mark with an X] Yes No If yes, please specify the type of service Do you provide play therapy? Yes No Membership fees paid by Self Employer Date Signature Can we add your info to the external resource database? Yes No FOR OFFICE USE ONLY Payment EFT Cash Invoice number Membership number Please be advised that all information provided should be updated with WCA for Play Therapy in the event of change CENTRAL KAROO Beaufort West Laingsburg Leeu-Gamka Matjiesfontein Merweville Murraysburg Nelspoort Prince Albert CAPE WINELANDS Ashton Bonnievale Ceres De Doorns Denneburg Franschhoek Gouda Kayamandi Klapmuts Kylemore Languedoc McGregor Montagu Op-die-Berg Paarl Pniel Prince Alfred Hamlet Rawsonville Robertson Robertsvlei Rozendal Saron Stellenbosch Touws River Tulbagh Wellington Wemmershoek Wolseley Worcester CAPE METROPOLE Atlantis Bellville Blue Downs Brackefell Cape Town Crossroads Durbanville Eerste River Elsie's River Fish Hoek Goodwood Gordon's Bay Gugulethu Hout Bay Khayelitsha Kraaifontein Kuils River Langa Macassar Melkbosstrand Mfuleni Milnerton Mitchell's Plain Noordhoek Nyanga Observatory Parow Simon's Town Somerset West Southern Suburbs Strand EDEN Albertinia Boggomsbaai Brenton-on-Sea Buffelsbaai Calitzdorp Dana Baai De Rust Dysselsdorp Friemersheim George Glentana Gouritsmond Great Brak River Groot-Jongensfontein Haarlem Hartenbos Heidelberg Herbertsdale Herolds Bay Keurboomsrivier Keurboomstrand Knysna Kranshoek Kurland Estate Ladismith Little Brak River Mossel Bay Nature's Valley Noetzie Oudtshoorn Pacaltsdorp Plettenberg Bay Port Beaufort Rheenendal Riversdale Sedgefield Slangrivier Stilbaai Uniondale Volmoed Victoria Bay Wilderness Wittedrift Zoar OVERBERG Arniston Baardskeerderbos Barrydale Betty's Bay Birkenhead Botrivier Bredasdorp Caledon Dennehof De Kelders Elgin Elim Fisherhaven Franskraalstrand Gansbaai Genadendal Grabouw Greyton Hawston Hermanus Hotagterklip Infanta Kleinbaai Kleinmond L'Agulhas Napier Onrusrivier Pearly Beach Pringle Bay Riviersonderend Rooi Els Stanford Struisbaai Suiderstrand Suurbraak Swellendam Van Dyksbaai Vermont Villiersdorp WEST COAST Aurora Bitterfontein Chatsworth Citrusdal Clanwilliam Darling Doringbaai Dwarskersbos Ebenhaeser Eendekuil Elands Bay Goedverwacht Graafwater Grotto Bay Hopefield Jacobsbaai Jakkalsfontein Kalbaskraal Klawer Koekenaap Koringberg Lamberts Bay Langebaan Langebaanweg Lutzville Malmesbury Moorreesburg Paternoster Piketberg Porterville Redelinghuys Riebeek-Kasteel Riebeek West Saldanha St Helena Bay Strandfontein Vanrhynsdorp Velddrif Vredenburg Vredendal Wupperthal Yzerfontein .