{"id":891,"date":"2026-02-13T18:59:37","date_gmt":"2026-02-13T18:59:37","guid":{"rendered":"https:\/\/newurhp.com\/?page_id=891"},"modified":"2026-09-02T15:32:35","modified_gmt":"2026-09-02T14:32:35","slug":"full-application","status":"publish","type":"page","link":"https:\/\/newurhp.com\/index.php\/full-application\/","title":{"rendered":"Full Application Form"},"content":{"rendered":"\n<div class=\"wp-block-stackable-heading stk-block-heading stk-block-heading--v2 stk-block stk-651ba27\" id=\"strong-application-form-for-full-urhp-membership-br-strong\" data-block-id=\"651ba27\"><style>.stk-651ba27 {margin-bottom:50px !important;}<\/style><h1 class=\"stk-block-heading__text\"><strong>Application Form for Full URHP Membership<br><\/strong><\/h1><\/div>\n\n\n\n<div class=\"wp-block-stackable-text stk-block-text stk-block stk-68abc81\" data-block-id=\"68abc81\"><p class=\"stk-block-text__text\">To apply for membership of the URHP, please complete the electronic form below and follow the steps through to completion. You do not pay any fees until you have completed the subsequent new member application process and have had your membership approved via our Education Committee.<\/p><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Your completed form is AUTOMATICALLY sent to the URHP Registrar&#8217;s email account.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please&nbsp;<strong>scan and email<\/strong>&nbsp;your CPD forms and insurance certificate to complete your application to:&nbsp;<a href=\"mailto:registrar@urhp.com\">registrar@urhp.com<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You will be sent an invoice for the membership fee with payment options.<\/p>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-stackable-columns alignfull stk-block-columns stk-block stk-64fe829 stk-block-background\" data-block-id=\"64fe829\"><style>.stk-64fe829 {background-color:#536b12 !important;border-top-left-radius:var(--stk--preset--border-radius--none, 0px) !important;border-top-right-radius:var(--stk--preset--border-radius--none, 0px) !important;border-bottom-right-radius:var(--stk--preset--border-radius--none, 0px) !important;border-bottom-left-radius:var(--stk--preset--border-radius--none, 0px) !important;overflow:hidden !important;box-shadow:none !important;border-style:solid !important;border-color:#000000 !important;border-top-width:0px !important;border-right-width:0px !important;border-bottom-width:0px !important;border-left-width:0px !important;min-height:400px !important;align-items:center !important;padding-top:var(--stk--preset--spacing--70, clamp(50px, 7vw, 90px)) !important;padding-right:var(--stk--preset--spacing--70, clamp(50px, 7vw, 90px)) !important;padding-bottom:var(--stk--preset--spacing--70, clamp(50px, 7vw, 90px)) !important;padding-left:var(--stk--preset--spacing--70, clamp(50px, 7vw, 90px)) !important;margin-bottom:0px !important;display:flex !important;}.stk-64fe829:before{background-color:#536b12 !important;}<\/style><div class=\"stk-row stk-inner-blocks stk-block-content stk-content-align stk-64fe829-column alignwide\">\n<div class=\"wp-block-stackable-column stk-block-column stk-column stk-block stk-56fdb24\" data-v=\"4\" data-block-id=\"56fdb24\"><div class=\"stk-column-wrapper stk-block-column__content stk-container stk-56fdb24-container stk--no-background stk--no-padding\"><div class=\"stk-block-content stk-inner-blocks stk-56fdb24-inner-blocks\">\n<div class=\"wp-block-stackable-heading stk-block-heading stk-block-heading--v2 stk-block stk-32a9496\" id=\"heading-placeholder\" data-block-id=\"32a9496\"><style>.stk-32a9496 .stk-block-heading__text{color:#ffffff !important;}<\/style><h2 class=\"stk-block-heading__text has-text-color\">Transform Your practice Today<\/h2><\/div>\n\n\n\n<div class=\"wp-block-stackable-text stk-block-text stk-block stk-52330ff\" data-block-id=\"52330ff\"><style>.stk-52330ff .stk-block-text__text{color:#ffffff !important;}<\/style><p class=\"stk-block-text__text has-text-color\">Click below to read our privacy policy before you submit your information.<\/p><\/div>\n\n\n\n<div class=\"wp-block-stackable-button-group stk-block-button-group stk-block stk-93f275c\" data-block-id=\"93f275c\"><div class=\"stk-row stk-inner-blocks stk-block-content stk-button-group\">\n<div class=\"wp-block-stackable-button stk-block-button stk-block stk-4cfaaf8\" data-block-id=\"4cfaaf8\"><style>.stk-4cfaaf8 .stk-button{background:#8bb31d !important;}.stk-4cfaaf8 .stk-button__inner-text{color:#ffffff !important;}<\/style><a class=\"stk-link stk-button stk--hover-effect-lift-scale-more\" href=\"https:\/\/newurhp.com\/index.php\/privacy\/\"><span class=\"has-text-color stk-button__inner-text\">Privacy Policy<\/span><\/a><\/div>\n<\/div><\/div>\n<\/div><\/div><\/div>\n<\/div><\/div>\n\n\n\n<div style=\"height:49px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-stackable-heading stk-block-heading stk-block-heading--v2 stk-block stk-1bb3261\" id=\"personal-details\" data-block-id=\"1bb3261\"><style>.stk-1bb3261 {margin-bottom:23px !important;}<\/style><h2 class=\"stk-block-heading__text\">Personal Details<\/h2><\/div>\n\n\n<style id=\"wpforms-css-vars-1360-block-d115932f-1de8-4d1a-b11c-827e59d4c86d\">\n\t\t\t\t#wpforms-1360.wpforms-block-d115932f-1de8-4d1a-b11c-827e59d4c86d {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-d115932f-1de8-4d1a-b11c-827e59d4c86d wpforms-render-modern\" id=\"wpforms-1360\"><form id=\"wpforms-form-1360\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1360\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/891\" data-token=\"c3966a65c034a3d803116c7f814d0809\" data-token-time=\"1793213812\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1360-field_8-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_8\">Title <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1360-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Select...\"  class=\"choice-7 depth-1\"  >Select&#8230;<\/option><option value=\"Mr\"  class=\"choice-1 depth-1\"  >Mr<\/option><option value=\"Mrs\"  class=\"choice-2 depth-1\"  >Mrs<\/option><option value=\"Miss\"  class=\"choice-3 depth-1\"  >Miss<\/option><option value=\"Ms\"  class=\"choice-5 depth-1\"  >Ms<\/option><option value=\"Mx\"  class=\"choice-4 depth-1\"  >Mx<\/option><option value=\"Doctor\"  class=\"choice-6 depth-1\"  >Doctor<\/option><\/select><\/div><div id=\"wpforms-1360-field_9-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1360-field_9\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][9][first]\" aria-errormessage=\"wpforms-1360-field_9-error\" required><label for=\"wpforms-1360-field_9\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1360-field_9-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][9][last]\" aria-errormessage=\"wpforms-1360-field_9-last-error\" required><label for=\"wpforms-1360-field_9-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1360-field_10-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_10\">Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1360-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" step=\"any\" aria-errormessage=\"wpforms-1360-field_10-error\" required><\/div><div id=\"wpforms-1360-field_11-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_11\">Internal Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1360-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1360-field_11-error\" required><\/div><div id=\"wpforms-1360-field_12-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_12\">Referral Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1360-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1360-field_12-error\" required><\/div>\t\t<div id=\"wpforms-1360-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1360-field_1\" >on ever about<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1360-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1360-field_13-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_13\">Include referral email address on URHP website and directory? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1360-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Select...\"  class=\"choice-1 depth-1\"  >Select&#8230;<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-3 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-1360-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_14\">Please list college\/school(s) attended, qualification, and date obtained <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-1360-field_14-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_15\">Main Clinic Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-1360-field_15-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_17-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_17\">Contact Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1360-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" step=\"any\" aria-errormessage=\"wpforms-1360-field_17-error\" required><\/div><div id=\"wpforms-1360-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_18\">Website <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1360-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1360-field_18-error\" required><\/div><div id=\"wpforms-1360-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_19\">Clinic Days\/Times <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-1360-field_19-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_20\">Other Clinics (include addresses, telephone numbers, and dates and times available) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-1360-field_20-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_21\">Please state the primary discipline you practice, eg. Western, Ayurvedic, Chinese <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-1360-field_21-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_24-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_24\">Other Therapies Practiced <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-1360-field_24-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_22-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_22\">Have you ever been refused membership of any other herbal register? If &#039;Yes&#039; please give details <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1360-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-1360-field_22-error\" required><\/textarea><\/div><div id=\"wpforms-1360-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_25\">Where did you hear about the URHP? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1360-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-1360-field_25-error\" required><\/div><div id=\"wpforms-1360-field_26-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1360-field_26\">Where are you based? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1360-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Select...\"  class=\"choice-1 depth-1\"  >Select&#8230;<\/option><option value=\"United Kingdom (UK)\"  class=\"choice-2 depth-1\"  >United Kingdom (UK)<\/option><option value=\"Europe (EU)\"  class=\"choice-3 depth-1\"  >Europe (EU)<\/option><\/select><\/div><div id=\"wpforms-1360-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Data consent <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1360-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1360-field_27_1\" name=\"wpforms[fields][27][]\" value=\"By checking this box you confirm that you have read and agree to our Terms of Service, and that you have read our Privacy Policy\" aria-errormessage=\"wpforms-1360-field_27_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1360-field_27_1\">By checking this box you confirm that you have read and agree to our Terms of Service, and that you have read our Privacy Policy<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1360-field_27_2\" name=\"wpforms[fields][27][]\" value=\"By checking this box you would like to receive more information about the URHP, events, training, and news\" aria-errormessage=\"wpforms-1360-field_27_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1360-field_27_2\">By checking this box you would like to receive more information about the URHP, events, training, and news<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1360-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1360-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1360-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LewkX4sAAAAAOmts257DouHzDu4NtNlzUKHClQD\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1360\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1793213812.e881627f3f150e5e690ac148ec4d4b91e7c080c4b0671cdeb1b611274fbaadd2\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/newurhp.com\/index.php\/wp-json\/wp\/v2\/pages\/891\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1360\" class=\"wpforms-submit\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/newurhp.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Application Form for Full URHP Membership To apply for membership of the URHP, please complete the electronic form below and follow the steps through to completion. 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