Online Application Form

Online Membership Application Form

I wish to apply for membership as *

Full/Associate
Student/Affiliate

List the Therapies you are applying for *

List of Therapies ,separated by comma

Your Name *

First

Middle

Last

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

Social Media Links

One per line , use full url including https;//

Name of Professional Bodies (if any) of which you are a Current Member:- (give FULL Name and Initials used by them)

I wish to apply for the ARCHTI Insurance Scheme

All Membership Categories have a Common Renewal Date of 16th February every year. Therefore, when joining during the year the following quarterly rates apply:-

DATE joining	17 Feb—16 May	17 May—16 Aug	17 Aug—16 Nov	17 Nov—16 Feb
FULL/Affiliate Fee	€80.00	€60.00	€40.00	€20.00
STUDENT/Associate Fee	€30.00	€25.00	€20.00	€15.00

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)

Notes

Before completing form, please ensure you have read the following:

Overview on How to Apply – Click here

And also these Information Instructions – Click Here

Please also note that the only payment required initially is our Application fee of €15 for the first 3 therapies being applied for and €5 per therapy after that.