Renewal Application for Membership

Annual Membership is £45.00 per year (subject to change). You will be notified of your acceptance & membership will start upon receipt of the fee.

Please complete the form below to renew your membership:

Name:
Business/surgery:
Email:
Are there any changes: YES NO
If yes, please complete the box below telling us of any changes.
Any new certificates, please send PDF/photo copies to: members@acupuncture-acutherapy.co.uk
Declarations
True False - I confirm that there have been no disciplinary findings against me.
True False - I confirm there have been no successful claims against my Professional Indemnity Insurance.
True False - I confirm that there are no outstanding professional complaints against me.
True False - I confirm that there have been no criminal convictions or cautions against me (not inc. motor offenses punishable only by a fine).
True False - I confirm that there are no health issues affecting my ability to practise.
True False - I confirm that I have Professional Indemnity Insurance to practise in my Country.
True False - I confirm that I will respond to any request from AcuC for evidence of my Professional Indemnity Insurance, CPD Activities and Qualifications.
If False to any of the above declarations, please explain below:
Insurance
Yes No - Do you require information about AcuC's approved Professional Indemnity Insurance?
Please insert your current Insurance Details:
Insurance Company:
Policy No:
Code of Professional Conduct and Safe Practice
True False - I have read and will comply with AcuC's Code of Professional Conduct & Safe Practice
Code of Professional Conduct and Safe Practice
Data Protection Act 2018 (GDPR)
Practice address(es) - the only publicly available information on the Register will be your name, town/city, postcode, telephone number of your practice, email and/or web address, disciplines for which you are registered and date on which your registration expires.