The Institute for Neuro-Physiological Psychology
GDPR Form for INPP Licentiateship
Contact Data
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Occupation
*
Organisation (if appropriate)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com - please note that this needs to be the same email that you used for your licentiate account.
Website
Year of certification
Date & place of last supervision
GDPR Acceptance
Please check both options below.
I authorise the processing of personal data contained in this form according to INPP's privacy policy
*
I agree
I acknowledge that my contact data as above will be available on INPP's website in my country for potential clients
*
I agree
Please sign below to confirm your agreement and acknowledgment of the GDPR policy.
*
Licentiates GDPR Form (EN03301B)
September 2024
INPP Ltd
inpp.cloud
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