Application form for registration

Section 1 – General Information

Are you a member of the Society? Yes No Have you ever been a member? Yes No
IF YOU HAVE A PASSWORD, PLEASE ENTER THE EMAIL ADDRESS THAT YOU USE TO LOG IN
EmailEmail Enter your password
Title Mr Ms Mrs Dr  
First name
Home address 1
Last name
Home address 2
Suffix
City/Town
Telephone (Landline) County
Telephone (Mobile) Country
Date of Birth (DD/MM/YY) Nationality
Course Provider Date of Qualification (DD/MM/YY)
Insurance Details (Company, Policy No. & Expiry Date) What is the exact name you wish to appear on your registration certificate

Section 2 – Practice Information (for inclusion on all lists made available to the public)

Please list clearly and accurately each address from which you practice and which you wish to appear on the all lists made available to the public. You may also include a website address.
Please enter https:// or http:// as appropriate, followed by your website address
Please enter https:// or http:// as appropriate, followed by your website address
IMPORTANT: In the event of name or contact detail change, it is your responsibility to notify the office

Section 3 – Declaration

Has your application for membership to any other professional organisation ever been refused?  Yes No
If yes, please give details
Do you have any special requirements or circumstances that you would like us to take into account when processing your application?   Yes No
If yes, please give details
I agree to undertake and record continuing professional development (CPD) and supervision, and will cooperate with the Society’s audit procedure (certificate of attendance) if and when I am asked to provide evidence. Minimum of 1 Homeopathic CPD per year. Yes No
I agree to undertake the free Tusla online training in respect of Children First on the Tusla website to upskill myself in the individual Homeopathic Practitioners roles and responsibility in relation to child protection and welfare.
www.tusla.ie/children-first/children-first-e-learning-programme.
Yes No
I agree to read and abide by the documents in the ISH Handbook which will be forwarded to me after my application has successfully been completed. Yes No
(If you have any queries please get in touch with the ISH for clarification)  
By submitting this form I confirm that:
  • I do not have any convictions for sexual offences or for abusing the trust of others in my care
  • I have read, understood and agree to the terms and conditions of the Registration process
  • I confirm that I will maintain up-to-date insurance
  • Upon acceptance of my application I undertake to abide by the regulations and Code of Ethics and Practice of the Irish Society of Homeopaths (download here)
  • I certify that the above information is true and correct.
Please note the following:
  • No member shall utilise the name, goodwill or facilities of the ISH for monetary gain, to enhance personal reputation, to solicit patients or to obtain personal wealth
  • Only those on the Society’s Register may use the titles “Registered Homeopath”, “Registered with the Irish Society of Homeopaths” and the abbreviation “IS Hom”
  • Members not on the Register may not use their membership nor the name of the Irish Society of Homeopaths nor any variation for professional purpose
  • The Society has the right to refuse admission at their absolute discretion.

Section 4 – Application for registration

I wish to register with the Irish Society of Homeopaths and will post the following: 
1) Copy of my course qualification (e.g. Licentiate/Diploma/Certificate)
        Or
A signed letter from the College Principal stating I have recently qualified but have not yet received my Licentiate/Diploma/Certificate
        Or
I have undertaken the Individual Route to Registration and my qualification is already on file





2) Curriculum Vitae
3) Two signed, original character references (please refer to document – ISH Registration Programme)
4) Copy of my current, up-to-date professional insurance certificate
5) I enclose cheque/postal order in the amount of €300 (make payable to the Irish Society of Homeopaths)
        Or
I wish to pay by monthly standing order and enclose S/O mandate and non-refundable deposit €125




IMPORTANT:
After submitting, please CLICK HERE TO PRINT THIS PAGE, write your signature and the date below, and send the signed page only to us with your application documents:
- either scan the signed form and email it to   info at irishhomeopathy.ie   (please replace " at " with "@")
- or send by post: Irish Society of Homeopaths, 1st Floor, Marine Court Centre, James's Terrace, Malahide, Co.Dublin, Ireland