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Become a member of the BHDA

Please complete and submit the form below to apply for membership of the BHDA. On submission of this form, you will be redirected to a page from where you can download a Direct Debit mandate. Please complete and sign this direct debit form, and return by post to the address indicated. Once we have received your completed submission and Direct Debit, you will be a member of the BHDA.

Do you want your name to appear on the BHDA website when you have your LFHom? Yes No First name Surname Professional Qualifications Name of Practice (if applicable) Address 1 Address 2 Address 3 City County Post Code Telephone Fax number (if any) Email address Website (if any)

Home Address 1 Home Address 2 City Post Code

Have you attended courses in Homeopathy? Yes No Do you use Homeopathy routinely in your practice? Yes No Do you have any Homeopathic qualifications ? Yes No If yes, what are they?

Are you an Associate of the Faculty of Homeopathy? Associate Licensed Associate No If no, do you intend to join? Yes No Is your Practice mercury-free? Yes No Is your Practice…? NHS Private Mixed What is your role? Dentist Hygienist Student Other Any special fields of interest?

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