Online Membership Application Form

Before completing form, please ensure you have read the following:

Overview on How to Apply - Click here

And also these Information Instructions - Click Here

Please also note that the only payment required initially is our Application fee of €15 for the first 3 therapies being applied for and €5 per therapy after that.

Membership Type

I wish to apply for membership as: Student Affiliate Associate Full

Personal Details

Title (Mr/Mrs/Other):

First Name *

Middle Name:

Last Name *

Home Address: *

Home Telephone: *

Mobile *

Practice Details

Do you have your own Practice ? Yes No *

Name of your Practice: *

Practice Address *

Practice Telephone: *

Practice Mobile Number *

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Website / Email Address

Website Address (if any):

Email Address

Website Listing

Tick which of the following details you would like to put on your Free listing on your Website:

Practice

Home

Mobile

Website

NONE

Therapies List

You MUST complete the information required for EACH THERAPY you wish to be registered for under Therapy Details section of this form otherwise we cannot process your application. (Please don't waste our time by listing any therapy for which you do not hold qualifications). STUDENTS should only list accredited courses which they are currently studying

List of Therapies which you are qualified to practice *

Insurance Details

Are you insured ? Yes No *

Please give details here of your Insurance and you will need to provide a copy of your Insurance Certificate, you can post this into us, email it to us or you will have the option at the end of this form to upload documents

Name of Insurance Company *

Policy Expiration Date: *

Do you Wish to Apply for the ARCHTI Insurance Scheme ? Yes No *

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Therapy Details

Therapy 1 Details:: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 2 Details *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 3 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 4 Details *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 5 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 6 Details *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 7 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 8 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 9 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 10 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 11 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Would you like to add details of another therapy ? Yes No *

Therapy 12 Details: *

Length in Practice *

Part Time / Full Time Part Time Full Time

Name of College / Training Facility Attended: *

Address *

Telephone *

Fax Number

Website

Email Address:

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Professional Bodies

Are you a member of any Professional Bodies ? Yes No

Name of Professional Bodies of which you are a Current Member:- (give FULL Name and Initials used by them) *

Nationality & Work Permit Details

Are you an Irish Citizen Yes No *

What country are you a citizen of ? *

Have you Irish Government permission to live and work in Ireland? Yes No *

Are you an EU Citizen Yes No *

Declarations

The following declarations MUST be answered or your online application will not submit

I am aware of the Rules and Regulations regarding Membership of the Association of Registered Complementary Health Therapists of Ireland and agree to be bound by them and further understand that if the Association at any time deems me unfit to continue to be a Member for breach thereof that Membership can be revoked and notification of same be made to all the Association's contacts. *

I hereby grant permission to the Association of Registered Complementary Health Therapists of Ireland to contact any association/school/institute/training course director named above should verification of qualifications be required and in the event of same not being made available or being unacceptable shall accept that the Association has the right to refuse membership without further explanation. *

I hereby grant permission to the Association of Registered Complementary Health Therapists of Ireland to contact any person/s, organisation, Government bodies, Police Forces, Military or whomsoever might be deemed necessary to investigate and verify the details contained in this application to be true. *

Have you ever been convicted for unprofessional conduct or serious personal offences in Ireland? Yes No *

Have you ever been convicted for unprofessional conduct or serious personal offences in any other country? Yes No *

Are you currently under investigation for unprofessional conduct or serious personal offences in any country? Yes No *

Are you currently under investigation for unprofessional conduct or been disciplined by any school/organisation? Yes No *

If answered Yes to any of above please enter details here: *

Payment

How do you intend to pay your Application fees ? Online By Post *

To Pay online, please submit this form first, then you will be given a link to our Online Payment Shopping Cart area which operates in Euros. If you wish to pay in Sterling, please email info@irishhtherapists.ie requesting a GBP invoice.

You can also chose to do the online payment at a later stage by clicking on the 'Shopping' link on our top menu bar of the website

Please note you can pay using any Credit card, Visa Debit card, 3v card or with a PayPal account. All payments will be processed securely on PayPal's secure servers.

Thank you.

Please post your payment to :

ARCHTI, Ballydaniel, Camolin, Enniscorthy, Co. Wexford.

Thank you

Submit Documentation

As part of your application you must submit:

Copies of Qualifications
Copy of Current Insurance Policy (if already insured)
Reference (if applicable)

You can upload scanned copies of these documents via our online Form Uploader (you will be given a link to this on the next page when your form submits). If you have a problem uploading your documents or using the online PayPal payment system please email us straight away at info@irishtherapists.ie for help

How do you intend to submit your documentation to us ? Upload Later Send by post *

Further Info

Where did you hear about us ? Google or other search engine Advertisement School/College ARCHTI Member Facebook Other

Other

Confirmation

I confirm that all the information I have provided on this online form can be verified to be true and correct at this date and that by typing my name in this box I am confirming this to be true at date of submission of this form *

Captcha

Please enter the characters in the graphic into the box to proove you are human, thank you

Captcha Code

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

THANK YOU,

Your form has been submitted successfully.

Next we require your supporting documentation and payment.

To proceed to upload files and use the online payment facility to pay your fees please click on the relevant links below.

Document Upload Form

Online Payment Page (Shopping Cart)

The links to these forms are also available if you click on “Forms” link on the top menu bar on our website. Thank you.

Online Membership Application Form

Before completing form, please ensure you have read the following:

Please also note that the only payment required initially is our Application fee of €15 for the first 3 therapies being applied for and €5 per therapy after that.

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

THANK YOU,

Your form has been submitted successfully.

Next we require your supporting documentation and payment.

To proceed to upload files and use the online payment facility to pay your fees please click on the relevant links below.

Document Upload Form

Online Payment Page (Shopping Cart)

Alternatively you can forward your documents and payment by post, please include your own personal details with any payments, thank you

If you would like to print or save a copy of your completed form please click on link here:

Online Membership Application Form

Before completing form, please ensure you have read the following:

Please also note that the only payment required initially is our Application fee of €15 for the first 3 therapies being applied for and €5 per therapy after that.

Please note if form doesn't proceed after you click button, please check top of page for input error notes, thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes, thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes, thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes, thank you

THANK YOU,

Your form has been submitted successfully.

Next we require your supporting documentation and payment.

To proceed to upload files and use the online payment facility to pay your fees please click on the relevant links below.

Document Upload Form

Online Payment Page (Shopping Cart)

Alternatively you can forward your documents and payment by post, please include your own personal details with any payments, thank you

If you would like to print or save a copy of your completed form please click on link here:

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you

Please note if form doesn't proceed after you click button, please check top of page for input error notes,
thank you