Network Registration - Irish Reflexologists' Institute

Network Information

Network Name *

Network Address *

Please provide the address where the Network Meetings will take place.

Network Leader Name (1) *

First

Last

Please provide the name of the primary Network Leader

Network Leader Name (2) - (Only if there is a second Network Leader)

First

Last

Only if there is a second Network Leader

Membership Number Leader (1) *

Membership Number Leader (2) - If Applicable

Network Email *

Confirm Email

Please provide a specific email address to be used for this Network. Please enter it twice to avoid typing errors.

Network Email *

Network Phone Number *

WEBSITE LISTING

All Networks will be listed on the website www.reflexology.ie. Please fill out the details below as you would like them to appear. Please note the details submitted here will be available for public viewing. It is recommended to use a separate phone/email if possible from your personal business.

Please list my Network on the IRI website *

Public Phone *

Public Email (optional)

Confirm Email

Social Media Page

List on Website

Price: € 5.00

Stripe Credit Card *

Card

Name on Card

LEGAL AGREEMENTS

You must give formal consent to the following in order to register your Network.

IRI Code of Ethics (details can be found on Website) *

I agree, that as Leader (1) of this Network, to be bound by the Irish Reflexologists' Institute Code of Ethics

Declaration *

I declare that all the information supplied in this form is true and accurate.

Name Network Leader (1) *

First

Last

Name Network Leader (2)

First

Last

Phone

Message