Application Form for Full URHP Membership

To apply for membership of the URHP, please complete the electronic form below and follow the steps through to completion. You DO NOT pay any fees until you have completed the subsequent new member application process and have had your membership approved via our Education Committee.

Your completed form is AUTOMATICALLY sent to the URHP Registrar's email account so there is no need to print off and send unless you wish to.

If this is the case, please return by post to URHP Registrar, 34 Hogarth Hill, London NW11 6BA.

Please scan and email your CPD forms and insurance certificate to complete your application to: urhpregistrar@yahoo.com

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

Please list college/school(s) attended, qualification, and date obtained:

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:

Have you ever been refused membership of any other herbal register? If 'Yes' please give details:

Where did you hear about the URHP?

I am based in

Payment Method:

I wish to pay in:

* 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.