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CANADIAN ASSOCIATION OF IRLEN PROFESSIONALS
REQUEST FOR CLINIC DIRECTOR MEMBERSHIP
Indicates required field
Phone Number (Primary)
Phone Number (Cell)
Phone Number (Office)
Clinic Director (full membership only)
When were you certified by the Institute? mm/dd/yy
In what areas or locations do you practice?
Indicate the average number of hours per month you spend on your Irlen practice.
Are you currently authorized by the Institute to train screeners?
How many screeners have you trained?
How many screeners have you trained that are still active?
By submitting this form,
you agree that if admitted to CAIP, will you fully and completely abide by its
Code of Ethics
Clinic Director membership fee: $500 per year.
Agree & Submit
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