INLPTA Membership Application

INLPTA Membership Application
Institut/company/person who certified you*
institut name
INLPTA Master-Trainer who certified you*

First NameLast Name
Date of your certification*

DayMonthYear
Date
picture of your INLPTA certificate*

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Application for INLPTA Membership
Your Name*

First NameLast Name
Gender*

femalemaleother
Birthdate*

DayMonthYear
Date
private Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
own Institute/Company / Office name
own Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
mobile Phone Number*

Country CodeArea CodePhone Number
Phone Number

Area CodePhone Number
Address Comments
Email (you will get a confirmation copy of your application to this email)*
example@example.com
your website
Types of Trainings or Special offers or Expertise
Comments / other things (e.g. Author or academic / organisational positions)
INLPTA membership agreement- Adhésion à l'INLPTAaccord
Code of ethics code ethique
INLPTA principles of training quality / Principes de qualité de la formation
I confirm that I have read, accept and comply to:*

membership agreement rulescode of ethicsINLPTA principles of training qualitycurricula of all INLPTA standards
I confirm that I agree that my Name and Address can be published on the INLPTA website as membership. Your data will be kept in the INLPTA database for membership purposes only. Your data privacy / DGSVO /GDPR will be respected and your Data will not be given to anyone.
Name and Address publication*

yes - I accept the publication of my name and address on INLPTA websiteno - I prefer that my name and address will not be published on the INLPTA website
Membership fees
The Membership in INLPTA currently costs 119 Euro (incl. VAT) per year.
You will receive an invoice at the beginning of each year.
The membership can be cancelled in writing or by email with a notice period of 3 months to the end of the year. Without cancellation, membership is automatically renewed for one year.

Agreement
The applicant agrees to the guidelines of INLPTA, the code of ethics, INLPTA membership agreement rules, curricula of all INLPTA standards, principles of training quality, and the terms of membership and declares that all information given above is true.
Signature (touchscreen device)

Clear
or upload pdf or picture with your signature

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notes / comments for the INLPTA office
Please verify that you are human*
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INLPTA Membership Application

Application for INLPTA Membership