Membership Application form – Homeopathy Education and Practitioners Association

Please enable JavaScript in your browser to complete this form.

- Step 1 of 3

Applicant Details

Name *

First

Last

Layout

Title

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Layout

Phone

Email *

Membership Details

Membership Type *

1. Details of training, including certificate given *

2. Details of practice, including approximate number of patients seen (if appropriate) *

3. A brief biography including education and work history *

1. Details of the programme you took, with dates of completion and any certificate given *

2. A brief biography including education and work history *

A brief biography including education and work history and why you are interested in joining HEPA. *

References and Media

Please provide two references: Name, Address, Phone number and Email

Reference 1 *

References 2 *

Layout

1 passport sized photo *

Click or drag a file to this area to upload.

CV or Resume *

Click or drag a file to this area to upload.

Layout

Copy of your diplomas or other relevant documentation *

Click or drag a file to this area to upload.

Copy of your diplomas or other relevant documentation (optional)

Click or drag a file to this area to upload.

Once your application has been received and processed, if accepted, you will receive four documents to review and sign. These are:
1. Code of Ethics of the organization (to be signed)
2. TMPC Code of Ethics
3. Guidelines for principled prescribing
4. Professional Protocols (To be signed)

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.