Student Membership Form Please enable JavaScript in your browser to complete this form.PERSONAL INFORMATIONName *FirstLastGender *FemaleMaleNon-binaryPrefer not to sayDate of Birth *CONTACT INFORMATIONEmail *EmailConfirm EmailPhone *Address 1 *Address 2 Town *Eircode County *CarlowCavanClareCorkDonegalDublinGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanNorthern IrelandOffalyRoscommonSligoTipperaryWaterfordWestmeathWexfordWicklowReflexology Training DetailsTraining School/College Name: *Title of Reflexology Course *Training Lecturer: *Training Lecturer Email: *EmailConfirm EmailAddress 1 *Address 2 Town *County *CarlowCavanClareCorkDonegalDublinGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanNorthern IrelandOffalyRoscommonSligoTipperaryWaterfordWestmeathWexfordWicklowEircode Phone *Course Start DateCourse End DateLEGAL RECORDS Is prosecution pending for a criminal offence? Or have you been convicted of a criminal offence in the last 12 months? *NOYESPlease provide detailsThis does not automatically exclude you from membership, we need to make an assessment.Are you currently on the Sex Offenders Register? *NOYESPlease provide detailsLEGAL AGREEMENTSI provide 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 CLG retain the information provided in this form. I understand it will be processed as needed for the operations of my student membership as determined by the governing committee, staff and IRI constitution. I understand this may include sharing details with Third parties as deemed necessary for my membershipCode of Conduct & Ethics Commitment and I have read and understood the policy *I, the undersigned, hereby apply to be a member of the Irish Reflexologists’ Institute CLG. I agree to be bound by the Irish Reflexologists’ Institute CLG 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 removed from the institute at the IRI Board’s discretion.PaymentMembership TypeStudent - € 0.00Total€ 0.00Stripe Credit Card *CardName on CardNameSubmit my Student Membership