* Required Field
Your first name as you wish it to be displayed: *
Your last name as you wish it to be displayed: *
Business name as you wish it to be displayed: *
Business website address:
Business telephone number including the country code: *
E-mail Address: *
Business email address (if different from above): *
Country that your business is in: *
County, province or state that your business is in *
Business address 1: *
Business address 2 (if applicable):
Business address 3 (if applicable):
Where or from whom did you learn colon hydrotherapy? *
How long have you been practising colon hydrotherapy? *
Company insured with: *
Insurance number: *
What colon hydrotherapy equipment do you use, including the make if applicable? (open or closed inc gravity or pressure device): *
What parts of your client kit are fully disposable?
If you don't use disposables, what is your sterilisation protocol?
What other therapies are you trained in and practice regularly?
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?
Do you commit or are you prepared to commit 30 hours per calendar year to continuing professional development? If you do, what would you like to learn or which courses would you like to attend in 2010? *
Do you wish to receive a numbered certificate with an embossed seal? (additional fee £10 for UK and Europe, £19 for Rest of the World) *
Are you attaching a photograph for your personal web page on the RICTAT website? (you, your colonic room, your clinic etc), or will you send them later? *
Attach a File:
When do you wish your subscription to start? *
Your full name: *
Submission date: *
