Student Membership Form - Irish Reflexologists' Institute

Name *

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Last

Gender *

Date of Birth *

Email *

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Phone *

Address 1 *

Address 2

Town *

Eircode

County *

Training School/College Name: *

Title of Reflexology Course *

Training Lecturer: *

Training Lecturer Email: *

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Address 1 *

Address 2

Town *

County *

Eircode

Phone *

Course Start Date

Course End Date

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 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.

Membership Type

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€ 0.00

Stripe Credit Card *

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