* denotes a required field.

Your first name as you wish it to be displayed: *

Your last name as you wish it to be displayed: *

The name of your business as you wish it to be displayed: *

The web address of your business:

Your business telephone number including the country code: *

Your business email address: *

The country that your business is in: *

The county, province or state that your business is in: *

Your business address or addresses (one per cell, max three per entry)

Your business address or address 1 *

Your business address 2 (if applicable):

Your business address 3 (if applicable):

Where or who from did you learn colon hydrotherapy? *

In what year did you qualify as a Colon Hydrotherapist? *

How long have you been practising colon hydrotherapy? *

What company are you insured with and what is the expiry date of your current policy? *

Please attach a copy of your current insurance certificate: *
Max file size: 100kb

What colon hydrotherapy equipment do you use, including the make if applicable? (open or closed inc gravity or pressure device)
Please note that the only form of sterilisation that we accept as safe is a hospital-quality autoclave. We are unable to offer membership to anyone using sterilising solutions.

Please confirm whether all the following parts of your client kit are fully disposable?

Speculum * Yes No

Water Inlet Tubing * Yes No

Waste Tubing * Yes No

What other therapies are you trained in and practice regularly? Other therapies

Why do you believe that you are an integrative colon hydrotherapist?
(Personal statement for your web page, 500 words maximum): *

Referees (names and email addresses please)

Colleague: *

Personal: *

Client: *

Is there anything else you wish to add about your professional activities or personal history, that is material to this application?

It is a requirement of RICTAT that members should complete a minimum of 30 hours CPD (professional development) within a 12-month period. This can be done by attendance at conference, study days, RICTAT on line courses or other related educational courses. This will be annually assessed and the time of your membership renewal. If you do, what would you like to learn or which courses would you like to attend? *

Please attach a photograph for your personal web page on the RICTAT website? Or email to register@rictat.org *
Max file size: 100kb

Do you wish to include membership of GRCCT? * Yes No

When do you wish your subscription to start? *

Your full name: *

Submission date: *