ELACTA Association Membership RENEWAL Form

Dear President!


ELACTA is collecting the necessary information and data online to renew the membership of its members for 2024. Please fill in the data in this form the latest before January 31, 2024 and you will receive a Membership and Cooperation Agreement between your association and ELACTA to sign. After the Agreement is signed, you will be sent a pro forma invoice for the payment of the membership fee.

Thank you for your cooperation! 

Email *
Date of filling
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Name and surname of the person who filled out the form *
Contact email  of the person who filled out the form *
Full Name of Association:
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Abbreviation
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Postal Address:  *
Zip Code/City/CityCountry
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Email (office/info/secretary):
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Website
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Name of President/Chairperson
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Email of president
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Phone:
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Name of Treasurer:
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Email of Treasurer:
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Total number of members in Association  on the 31, December, 2023
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Number of members who apply for Elacta membership (if different)  on the last day of the previous year. Membership fee will be calculated based on this number.
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How many have the IBCLC certificate of those who want to be members of ELACTA?
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How many do not have the IBCLC certificate
of those who want to be members of ELACTA? *


I confirm that the provided data is correct and based on the numbers  on 31 December, 2023 .
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I accept ELACTA Association Membership conditions
I accept the privacy policy. See more on Privacy policy   *
After the February 10, 2024 you will receive the Membership and Cooperation Agreement to sign. After the agreement is signed you will be sent a pro forma invoice for the payment of the membership fee. 
Thank you for being with ELACTA and strengthening the IBCLC network in Europe. 
A copy of your responses will be emailed to the address you provided.
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