ODPN Membership Application Form

Membership Application Form
Organization Development Practitioners Network, Inc. (ODPN) respects your privacy and will keep secure and confidential all personal and sensitive information that you may provide in this membership application form.
Date of Application

MonthDayYear
Date
Membership Type*

Individual Membership (You are applying as an individual OD practitioner.) Php2,500.00Corporate Membership (You are applying as a Corporate Primary Representative for your OD practitioners in the company.) Php5,000.00
Name*

PrefixFirst NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Cellular Number*

Area CodePhone Number
Please check the applicable box, if you are working:*

as an Independent HR or OD consultantin a company
If an Independent HR/OD Consultant, how long have you been one?
If you are working in a company, please answer questions A - H:
A. Name of Company
B. Company Address
C. Company Phone Number

Area CodePhone Number
D. Your Position in the Company
E. No. of Years in the Company
F. Industry/Nature of Business
G. Do you have an OD Division or Department?
H. If you are not the same person, please give the name of your HR or OD head and the official position/title
Total No. of Years in OD
Are you willing to be a member in any of the Organization's committees? If yes, please check your preference:

MembershipProgramsPromotions and MarketingWays and MeansResearch and Development
I certify that all information in this application is true and correct. I hereby allow ODPN to investigate all details made in this application and authorize ODPN to have access to and to use the same details for administrative purposes.
Signature

Clear
Signature Date

MonthDayYear
Date
IMPORTANT NOTES:

1. We only accept payments via bank deposit or bank transfer to:
Bank: Bank of the Philippine Islands or BPI
Account Name: Organization Devt. Practitioners Network
Account #: 3201-0394-19

Please send a copy of the deposit slip or bank transfer as proof of payment to odpnsecretariat@gmail.com and odpnacctng@gmail.com.

2. We send Statements of Account (if needed) and Official Receipts via email. Should you need an original copy of either, we will ask you to please handle the courier charges or get them in the next session, when participation can be in person.

3. Membership is renewable every January of the year.
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