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European Cranial and Complementary Medical Association

Membership Form

Name:

Contact Address:

DoB:

Tel No: ............................ Fax No: .......................... Email:

Qualifications

Complementary practitioner:

 

Cranial trained practitioner:

 

Complementary therapeutic:

 

Conventional medical practice:

 

Apprenticeships:

 

Membership (See overleaf for membership categories)

Full  (£70)* Associate  (£50)* License  (£ 30)* Affiliate  (£ 100)

Institute  (£100) Individual Network  (£ 25) Group Network  (£50)

*On-site placements through the Association will require specialist insurance.

Please list any therapeutic clinical experience (complementary or conventional):

 

 

Please enclose copies of qualifications, insurance and two passport photographs.

I undertake to abide by the Code of Ethics of the European Association

Signed: . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . .

Please print of return your application to:

CMSP Ireland, P.O. Box 1, Knockanarrigan, County Wicklow, Tel/Fax: Ireland 045404584

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