Faculty of Homeopathy Membership Application Form

	A P P L I C A T I O N F O R M Please ensure that you complete all sections in this form. When you are sure all sections have been completed press the Submit button at the bottom of the form to send your application to us. Alternatively, click the link below to download an application form that you can post to us along with your payment. Application form indicates required information.			Overview Discussion forum Education & training Membership Events diary CPD C O N T A C T U S S I T E M A P H O M E
	Select Type of Membership: Student Associate Licenced Associate Member Title

Enter Personal Details:

Family name:

Main Work Address:

Postcode:

Telephone:

Fax:

Email:

Preferred Mail Address:

Main Work
Home

Professional Information:

Job Title:

Professional Qualifications gained:

Place of training:

Professional body and
registration number:

Date of registration:

Professional indemnity organisation
and registration number:

First Name:

Home Address:

Home Postcode:

Home Telephone:

Home Fax:

Home Email:

Annual Subscription -
Methods of Payment:

Direct Debit (UK bank accounts only)
I wish to set up a direct debit payable to the Faculty of Homeopathy. Please send me a direct debit mandate form.

Payment by cheque
I will send a cheque payable to the Faculty of Homeopathy for £

Credit Card (we regret that we do not accept American Express)
Please submit this form and a bill will be forwarded to you.