Irish Association of Physical Therapists

I wish to be considered for Membership / continued Membership and Registration with the Irish Association of Physical Therapists.*

Yes
No

I allow / do not allow, (select where appropriate) as outlined in the above Data Protection release document the use of my details.*

Allow
Do not allow

I confirm that I have not been convicted of any criminal offence (excluding convictions and proceedings under the Road Traffic Legislation). If you have been convicted, then please indicate what the conviction is in respect of. The Professional Body reserves the right to request further information from you in respect of this if the Committee deems it necessary.*

Not Convicted
Convicted

If Yes to above then please give details

Health & Safety Compliance: I confirm that I have read the IAPT Health & Safety document relating to the Safety Statement and Risk Assessments and I am aware that I should display a Safety Statement in my practice / clinic.*

Yes
No

No formal complaints that have or will affect my professional insurance indemnity*

No
Yes

Terms and Conditions

Terms Conditions and Compliance

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