Add Additional Therapy to Existing membership

Your Name *

First

Middle

Last

Membership Number *

Your Email *

Confirm Email

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Mobile Phone

Name of your Practice (if Any)

Practice Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Practice Phone

Practice Website / URL

The Cost of Adding EACH NEW Therapy is €5 per Therapy. There are NO Refunds , so please make sure that your new therapy is a valid stand-alone "complementary health therapy " and not just an "in house" module for a therapy which you have already been registered for. If you are not sure , please ask your Trainer before submission to us.

List the Therapy/ies which you wish to ADD to those already registered.

I have insurance with the ARCHTI Group scheme and I wish to ADD this new therapy/ies to my policy *

(please note that you will apply directly to Balens and that they may charge for this service)

If you need more space to list your therapies please ask us to send you additional pages. • If your qualifications are not in the English Language please provide a certified translation of them. • If your qualifications have been received from a non-Irish or UK Training Facility please contact them and have them provide you (or us) with information on who their training course is accredited by.

Therapy (1) for which you wish to register:

Therapy(1)

Qualification Received (1)

Name of College/Training Facility Attended (1)

Address of College/Training Facility Attended (1)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Training Facility Phone (1)

Training Facility Email (1)

Training Facility Website / URL (1)

Qualification Image File Upload (1)

PLEASE ATTACH COPIES OF QUALIFICATION — no need to take out of frame if copy is clear enough to read
PLEASE NOTE: any of the above details which cannot be verified by the Membership Committee or the Officers of ARCHTI will not be accepted for registration so it is up to the Applicant to provide as much detail as necessary in order to have their Therapy registered.
Allowed formats *.jpg , *.png, *.gif

Therapy (2) for which you wish to register

Therapy Name (2)

Qualification Received (2)

Name of College/Training Facility Attended (2)

Address of College/Training Facility Attended (2)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Training Facility Phone (2)

Training Facility Email (2)

Training Facility Website / URL (2)

Qualification Image File Upload (2)

Therapy (3) for which you wish to register

Therapy Name (3)

Qualification Received (3)

Name of College/Training Facility Attended (3)

Address of College/Training Facility Attended (3)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Training Facility Phone (3)

Training Facility Email (3)

Training Facility Website / URL (3)

Qualification Image File Upload (3)

Comment

Cost to Add additional Therapies is €5 per therapy

Once form Completed , Remember to pay for added Therapies here