Associate Member Form - Irish Reflexologists' Institute

Complete all the below fields for New or Renewal Associate Membership

Name *

First

Last

Gender *

Date of Birth *//

IRI Membership Number *

Email *

Confirm Email

Please enter it twice to ensure no typing errors.

Phone *

Address 1 *

Address 2 (if needed)

Town *

Eircode (optional, but recommended)

County *

Is prosecution pending for a criminal offence? Or have you been convicted of a criminal offence in the last 12 months? *

Are you currently on the Sex Offenders Register? *

I provide formal consent to the following in order to be a member of the Irish Reflexologist's Institute.

Code of Conduct & Ethics Commitment *

I, the undersigned, hereby apply to be a member of the Irish Reflexologists’ Institute Limited. I agree to be bound by the Irish Reflexologists’ Institute Limited Code of Ethics and Practice.

Declaration *

I declare that all information supplied is true & accurate. If this is found not to be the case, members can be suspended or expelled from the institute at the IRIL Board’s discretion.

Membership Type

Members Pin Badge

Total

€ 0.00

Credit Card *

Card

Name on Card

Total

€ 0.00

Phone