Member Retention Form

chiropractic association of ireland application for retention of membership

CAI Membership Retention Form 2026

Form must be uploaded to the Members Portal and payment made online by 10^th of January of the next Membership Year. Continuous CAI Membership is necessary, also to avail of CAI Indemnity Policy. The details that you enter on this form will be held on file by the CAI for up to eight years even if membership ceases. Information entered on this form may be disclosed to companies providing medical malpractice and public/product liability insurance to CAI. Membership Name and number may also be disclosed to Health Insurance Companies (LAYA, VHI etc.) for patient reimbursement. Practice details will be shared with the ECU/WFC. Contact caiadmin@chiropractic.ie for the Members Privacy Policy.

Step 1Step 2Step 3

Section 1: Details of Applicant

Title

Title is required.

Surname:

Surname is required.

First Name:

First Name is required.

Name of Practice:

Owner of Practice/Business

Owner Name (if not yourself):

Address of practice:

Main Telephone number:

Website:

Clinic Email Address: (For CAI Website)

Name, address, phone no & owner of other/second clinic(s):

Personal Mobile:

E‑mail (for CAI to use)

Home Address:

Eircode

Membership type; Full / Non‑Practicing* / Overseas / Honorary — *Republic of Ireland

Membership Type is required.

Techniques Practiced:

Section 2: Your Health

A) Have you had a medical/psychological condition, since your last application for membership/renewal, that prevented you from practising chiropractic for over 3 months?

Please select Yes or No.

Section 3: Criminal Offences

A) Since your last application for membership/renewal have you been convicted of a criminal offence in any jurisdiction? (Please Select: Yes / No)

Please select Yes or No.

Section 4: Professional Negligence

A) Since your last application for membership/renewal, are you aware of any allegation of professional negligence or professional misconduct in relation to you as a Chiropractor or your Chiropractic Practice/Clinic? e.g., Solicitor or patient letter stating the above. Select: (Yes / No)

Please select Yes or No.

C) Has any allegation of negligence or misconduct been upheld since your last application for membership? (Please Select: Yes / No)

Please select Yes or No.

E) I agree to inform the CAI and my Professional Indemnity insurer as promptly as possible, of any potential claim against me. (Please Select: Yes / No)

Please select Yes or No.

Section 5: Professional Indemnity Insurance

Please give the following details of your professional indemnity insurance. Adherence to CAI’s minimum cover is mandatory: Current Cover: Professional Liability – €3,000,000. This may be subject to change 1^st April 2026.

A) The name of your Insurer:

Insurer name is required.

B) Name of Agent:

Agent name is required.

C) The date on which cover expires:

Expiry date is required.

D) The amount of cover provided:

Cover amount is required.

Section 6: Membership of Professional Bodies

A) Since your last application for membership, have you been refused membership/registration to any chiropractic organization, board, or regulatory body, or had any decision upheld against you by any chiropractic body or registration board? (Please Select: Yes / No)

Please select Yes or No.

Section 7: Declaration

CAUTION: Applicants are reminded that if any information on this form is fraudulent, they may find themselves subject to disciplinary proceedings.

Please complete and upload your Retention Form on the Members Portal and make payment Online. If you wish to avail of Premium Credit email: caiadmin@chiropractic.ie and see item 1 below.

Note: A late fee of 10% applies to all payments after 10^th January of the next Membership Year. Unpaid accounts past 1^st of February, face termination of membership as per Article 4 item 7 of the Members Charter. Special consideration may be given, if requested prior to December 15th, of the current Membership Retention Year.

Financing – Premium Credit (PC) is a financing company that allows you to spread the payments over time. Due to the length of time needed to set this up, you must contact admin by Dec. 1^st, to indicate your interest. All documents needed for PC are to be with admin by: December 10^th. No exceptions allowed as PC takes a minimum of 6 weeks to process payments. Our Constitution dictates that members’ dues must be paid by the AGM. This is the reason for the deadline.

I wish to avail of Premium Credit. Please make payment of €25. Premium Credit Admin fee. In payment options below.

Declaration (read and confirm)

I declare that all information supplied by me in support of my retention of membership with the Chiropractic Association of Ireland is, to the best of my knowledge and belief, true and accurate. I agree to be bound by the Code of Ethics, Constitution, Members Charter and Standards of Practice of the Association and such guidelines and standards as may be issued from time to time by the Executive Council of the Association. I irrevocably authorize my professional indemnity agent/insurers to communicate with the Executive and Administrator of the CAI; in respect of my indemnity insurance and any claim or potential claim notified to such agent/insurers. I understand that the Executive may take steps to verify information about me. I undertake to inform the CAI in advance, if I cease practice or leave the Republic of Ireland and to provide a forwarding address.

I confirm the above declaration.

You must agree to the declaration.

Consent GDPR

Please note, that by signing below you agree to allow the Chiropractic Association of Ireland (CAI) to store and process any data that you supply, e.g., name, phone number, e‑mail address etc., in accordance with General Data Protection Regulations. We may also add your Data to our database and bulk e‑mail service, MailChimp, in order to update you on policy and procedure change.

I consent to data processing as above.

You must provide GDPR consent.

I enclose a fee:

Signed:

Signature name is required.

Dated:

Date is required.

Membership Fee

Please select a membership fee.

Secure Payment

Enter card details to pay membership dues and submit the application.

Member Retention Form

CAI Membership Retention Form 2026

Section 1: Details of Applicant

Section 2: Your Health

Section 3: Criminal Offences

Section 4: Professional Negligence

Section 5: Professional Indemnity Insurance

Section 6: Membership of Professional Bodies

Section 7: Declaration

Secure Payment

World Federation Of Chiropractic

European Chiropractors’ Union