SA Reflexology Society - The SA Reflexology Society Membership Application Form -

Application is subject to the said membership category qualifications, submission of certified copies of qualification and registration with AHPCSA. Once proof of payment has been received your application will be processed. Please use your full name as reference on the deposit slip.

Application:

Title:

Name:

Surname:

ID No.:

Home Language:

Postal Address:

Postal Code:

Physical Address:

Postal Code:

Practice Address:

Postal Code:

Home Tel:

Practice Tel:

Other Contact Tel:

Fax:

Cell:

Email:

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Demographics for Statistical Purposes – Legal requirement

Sex:

Race:

Ability

Are you involved in under-privileged, black and rural areas community

If yes

Voluntary employed:

Name of institution/organisation

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Allied Health Professional Council of South Africa - Registration No.:

Practice No.:

Other Registered Qualifications:

Registration numbers of other Qualifications:

Registration number 1:

Registration number 2:

I currently practice:

I use the Vacuflexsystem [boots]:

Name of Reflexology Training Institution:

Date Qualified:

For Students only: Date of enrolment as student:

For Registered Therapeutic Reflexologist only: Contact numbers to be displayed on TSARS website:

Display Home No.?

Yes

No

Display Practice No.?

Yes

No

Display other contact no.?

Yes

No

Display Cell no.?

Yes

No

Display email address?

Yes

No

Do you have Professional Indemnity Insurance cover?:

Current date

I declare that all the information I have given in this form is true and correct.

I agree to abide by the rules as laid down in the Constitution and to follow the Codes of Ethics of TSARS.