Membership Renewal Form - Irish Reflexologists' Institute

Please complete this Membership Application Form to renew your IRI Membership.

PERSONAL INFORMATION

Name *

First

Last

Gender *

Date of Birth *//

IRI Membership Number *

Enter 4 digits, where your membership number is only 2/3 digits add a zero

CONTACT INFORMATION

Email *

Confirm Email

Phone *

Address 1 *

Address 2 (if needed)

Town *

Eircode (optional, but recommended)

County *

INSURANCE

Name of Insurance Company *

Policy Number *

Expiry Date *

FIRST AID

Current First Aid Certificate/BLS Provider Card/Employer Confirmation Letter *

First Aid Certificate
Medically Qualified - BLS Provider Card
Medically Qualified - Employer Confirmation Letter

Please tick one box. Non medically trained must provide a valid First Aid Certificate. Please see requirements listed under Membership on www.reflexology.ie. Medically trained can provide either a BLS Provider Card as issued by the HSE or a Letter from Employer/HSE/Hospital stating that First Aid Training has been completed. These are all valid for 2 years from date of completion of training.

Name of First Aid Training Company *

Please provide the name of the company that provided the First Aid Training/BLS Training.

Title of course as stated on First Aid Certificate/BLS Provider Card *

Please provide the title of the course that your qualification relates to

Expiry Date on First Aid Certificate *

Please provide the expiry date as stated on your First Aid Certificate/BLS Provider Card

Continuous Professional Development (CPD)

I confirm I have completed 100 CPD points for my renewal application *

LEGAL RECORDS

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? *

WEBSITE LISTING

This section is only if you wish to be added to the Website Listing or change your listed details Add the details you wish to be listed on the Find A Reflexologist Page. If a box is empty, it is assumed you do not want that item on the website. Your personal address is not added, only the locality.

Do you want change your listing on our website? (Please note Lapsed Members need to select yes to be relisted) *

Website Listing Disclaimer

By opting to list your details in the “Find a Reflexologist” search, you permit Irish Reflexologists’ Institute Ltd to pass your name and contact details to persons and organisations who enquire about Reflexology. The IRIL does not and cannot control who receives this information, and cannot be held liable for any matters arising from the provision of these details.

LEGAL AGREEMENTS

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

Membership Codes of Ethics & Practice *

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 Membership Codes of Ethics & Practice. (See Membership Requirements)

Insurance Commitment *

I agree to always hold Public Liability and Malpractice Insurance (clearly stating Reflexology as a therapy covered) whilst in Membership. I agree to provide copy of my Insurance Policy as requested during an audit review of my membership. I agree to maintain the terms of agreement of my membership and I understand this includes maintaining my insurance cover during my membership term.

First Aid Certifcate Commitment *

I agree to always hold current First Aid Certificate/Health Care Provider Card whilst in Membership. I agree to provide a copy of my First Aid certificate/Heath Care Provider Card as requested during an audit review of my membership. I agree to maintain the terms of agreement of my membership and I understand this includes maintaining my First Aid cover during my membership term.

CPD Commitment *

I agree to maintain 100 CPD points for my annual renewal whilst in Membership. I agree to provide copies of all CPD Certificates/details and CPD Form as requested during an audit review of my membership

IRI Logo Usage Contract: For Full members who wish to use IRIL Logo on your business stationery. *

I agree to be bound by the following in relation to the IRIL Logo.The IRIL logo belongs solely to the Irish Reflexologists Institute Limited. Usage of said logo is allowed only by current , up to date members of the Institute in conjunction with usage as a member of the institute; any breach of same, using the logo without making evident that it is the logo of the IRIL, is a breach of the terms of usage and an infringement on the ownership of same to the IRIL which will result in a suspension of membership.

Declaration *

I have read and understood the terms and conditions as stated above and I agree to maintain these as conditions of my membership. 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 on a case by case basis. I understand that if I do not maintain all of the above requirements my IRI membership will be suspended.

Payment

Discount Code

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Members Pin Badge

Members Pin Badge - € 7.00

Total

€ 0.00

Credit Card *

Card

Name on Card

Name