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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 (Membership Enquiries), Cornbrook Bridge House, Clee Hill, Ludlow, Shropshire, SY8 3QQ.

Please enclose the following with your application form:

  1. CPD Form(s) and number of credits claimed
  2. Additional Qualifications Certificates
  3. Copy of Insurance Certificate
  4. Cheque(s) for membership fees, payable to URHP (we do not take credit cards). Click here for fees information (opens in new window).
  5. 10 business cards
  6. 10 clinic leaflets
  7. Copy of CRB form
  8. 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.