Persons Application Form

Please fill personal application form to get a free membership

PERSONAL DETAILS

INSURANCE DETAILS

MLD Ireland requires practicing members to hold professional indemnity insurance. Please upload a photocopy of your valid policy document or copy of validation by your employer.

Insurance through employer:

YesNo

MLD CERTIFICATION

MLD Ireland requires practicing members to review their MLD certification on a biannual basis. Please upload a photocopy of your certificate to match membership.

I confirm that I have uploaded the correct and up-to-date documents required for membership (including insurance, CPD/education certificates, and any other supporting documents).

I understand that MLD Ireland reserves the right to refuse or decline if the documents provided are incomplete, inaccurate, invalid, or do not meet the eligibility guidelines.

BUSINESS ADDRESS

Please provide your business contact details for our records. This information may also be used for public listings.

DATA PROTECTION ACT

To comply with Data Protection Act requirements, please confirm the following:

I permit to place the following on the MLD Ireland website www.mldireland.ie under ‘Find a Therapist’

Business contact information:

YesNo

Business profile (written by me):

YesNo

signature :

(Block Capitals)

Bank information for payment of fees: MLD Ireland AC Num: 67792559 IBAN: IE04BOFI90190967792559

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Persons Application Form

Please fill personal application form to get a free membership

PERSONAL DETAILS

INSURANCE DETAILS

MLD CERTIFICATION

BUSINESS ADDRESS

DATA PROTECTION ACT

I permit to place the following on the MLD Ireland website www.mldireland.ie under ‘Find a Therapist’

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