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Application Form for Full Practicing Membership

To apply for full membership of the URHP, please complete the following form and click 'Printable Version'. This will produce a printable version which you will need to sign and return to: URHP, The Hamlet House, Coggleshall Hamlet, Essex CO6 1RQ.

Please enclose the following with your application form:

Essential Enclosures:

  1. Membership fees Click here for fees information (opens in new window).
  2. Copy of Insurance Certificate
  3. CPD Form(s) and number of credits claimed

Optional Enclosures:

  1. Copy of CRB form
  2. Additional Qualifications Certificates
  3. 10 clinic leaflets/business cards
  4. On a CD, a digital photograph of yourself, and an up-to-date profile for the URHP website, directions to the clinic, etc. (Optional)
Personal Details
Title:
Name:
Home Address:
Telephone Number:
Internal Email Address *:
Referral Email Address **:
 Include referral email address on URHP website and directory? **
Clinic Details and Qualifications for our website and referral list
Qualifications, Training Colleges/Schools:
Main Clinic Address:
Contact Number:
Website Address:
Clinic Days/Times:
Other Clinics
(include addresses, telephone numbers, and dates and times available):
Please state the primary discipline you practice, eg. Western, Ayurvedic, Chinese:
Other Therapies Practiced:
I wish to apply for Membership of the URHP.
Payment Details
Total Payable:
(click here for fee details)
 


* For safety alerts & URHP/EHTPA internal communications; too much volume to send by post.
** For referrals. Email address is not visible on URHP website Directory. An online contact form is provided instead.