Registration Form - CERPs International
Email address *
Name *
Family Name *
Please, specify if you are an ELACTA member. We will verify this information. *
If you are not sure, contact your country association. If you want to join ELACTA as an individual member:
If you are ELACTA member through your country association, tell us which association it is:
Are you an IBCLC? *
What is your IBCLC number? We will verify this information. *
This information is required for the CERPs certificate, please, do NOT forget it. If you are not an IBCLC just write "NO".
In which category do you apply? (if you don't know it means you are a "Registrant") *
Have you read and agree to the ELACTA's privacy policy? *
Do you agree to be contacted about future events and activities by ELACTA? *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of ELACTA. Report Abuse