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Membership Form

Our Annual membership runs from 1st April to the 31st March.

If you would like to print our membership form, click application form (PDF).

You can also apply to be on this website once you are a member

Data protection: By submitting your details using the form below, you are agreeing to the  Chiropody group holding your information.

Use the form below to apply for a listing on this website.

    In order to proceed we need your permission. The processing of the personal information collected in this form is subject to the conditions of our privacy policy.
  • Member Details

  • List your qualifications here.
  • Contact Details

  • Home Address

  • Surgery Address

  • Your surgery or business name, if you have one.
  • Profile Details

  • What title would you like on your profile page? This can simply be your name or it could be the name of your surgery.
  • Write a description of not more than 300 words about yourself and the services you offer. Visit other member profiles on the site for ideas. (Please note that this field has a 1500 character limit)
  • Please upload a portrait image of yourself or your business. For best results use an image that is 300 pixels wide and 300 pixels high. Images will be resized to these dimensions for display.
  • Add an image of your certification. Add an image of no more than 1000 pixels wide.
  • Add an image of your insurance document. Add an image of no more than 1000 pixels wide.
  • Social and Web Links

  • If you have one, please provide a link to your website.
  • If you have one, provide your twitter name.