Irish Reflexologist's Institute

Promoting professional reflexology in Ireland

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New Member Form

Please complete this Membership Application form to join the IRIL. You will need to upload a scanned copy of your Qualification Certificate and Insurance Policy and First Aid Certificate

PERSONAL INFORMATION

Name *

First

Last

Gender *

Date of Birth *//

CONTACT INFORMATION

Email *

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 *

QUALIFICATION DETAILS

Please enter the full details of your qualification in REFLEXOLOGY here. You will need to upload a scan or photo of your certificate.

Awarding Body *

Enter the body which certified you (eg: ITEC, VTCT). Some schools self-certify. If that applies to you, enter the name of the school.

Training School *

Enter the name of the school where you trained. If this was also the certifying body you listed above, enter it again here.

Date of Qualification *

Certificate File Upload

Upload a copy of your Reflexology Qualification here. Permitted formats are PDF, JPG, PNG, GIF. File size may not exceed 5MB.

INSURANCE

Name of Insurance Company *

Policy Number *

Expiry Date *

Does your policy specifically state that Reflexology is covered? *

YES
NO

Insurance Policy

Upload a copy of your Insurance Policy. Permitted formats are PDF, JPG, PNG, GIF. File size may not exceed 5MB.

FIRST AID

Do you have a First Aid certificate or a Healthcare Provider's Card? *

First Aid Certificate
Healthcare Provider's Card
I am not qualified to give first aid

Name of First Aid course provider

Only if you have a First Aid certificate.

Title of course as stated on your First Aid certificate

Only if you have a First Aid certificate.

Expiry Date on First Aid certificate

Only if you have a First Aid certificate.

Type of Healthcare Provider Card

Only if you have a Healthcare Provider Card

Expiry Date on Healthcare Provider Card

Only if you have a Healthcare Provider Card

First Aid Certifcate

Upload a copy of your Insurance Policy. Permitted formats are PDF, JPG, PNG, GIF. File size may not exceed 5MB.

LEGAL RECORDS

Have you ever been convicted of, or is prosecution pending for, a criminal offence? *

NO
YES

Please provide details

This does not automatically exclude you from membership, we need to make an assessment.

Are you currently on the Sex Offenders Register? *

NO
YES

Please provide details

WEBSITE LISTING

All approved IRI members have the option to be listed on our website. You do not have to use the same details as you gave us. For your safety, we recommend you have a separate phone and email just for your reflexology practice. Provide details as you want them on the site.

Do you want to be listed on our website? *

YES
NO

Name for Public Viewing *

First

Last

Public Phone

Public Email (optional)

Website / URL (optional)

Name of Therapy Practice - if any (optional)

Town(s) *

You can only be listed once. If you list more than one town, we will print them all in your listing, but your listing will be placed under the first town you provide.

LEGAL AGREEMENTS

You must give formal consent to the following in order to be a member of the Irish Reflexologist's Institute.

GDPR Agreement *

I consent to having the Irish Reflexologist's Institute Ltd retain the information provided in this form. I understand it will be processed as needed for the operations of the Institute as determined by the governing committee, staff and IRI constitution. I understand this may include sharing details with Healthcare Insurance Providers.

Code of Conduct Commitment *