Individual Member Application  Form 2024

This form is to initiate the AGREEMENT between ELACTA and Indivudual Member to perform mutual obligations during the period of the agreement.

ELACTA Membership forms are set out in clause 4 of the ELACTA Statutes. This Membership Form is for membership of INDIVIDUALS who have no professional associations in their countries, or their country association is not a member of ELACTA. If there is an ELACTA Member Association in your country, please apply for ELACTA membership through it.  

After filling in the data, you will receive a Membership and Cooperation Agreement and pro forma invoice for the payment of the membership fee. Your membership will start after paying the membership fee.

As a member of ELACTA you are a part of growing network of IBCLC’s in Europe!
Email *
Date of filling *
MM
/
DD
/
YYYY
First name *
Last name *
Are you IBCLC *
IBCLC number (if you are not an IBCLC write NO) *
Postal Address *
Zip Code *
City *
Country *
Email *
Are you a  member of an association of IBCLCs in your or other country ? *
If yes, which?
Usually individual  members are from the countries where there is no national IBCLC's Associations and they receive ELACTA journal Lactation&Breastfeeding in pdf format online. If you wish in addition to receive the German version of the journal  “Laktation & Stillen”, please fill in the next boxes.  
I wish to get online-access to the English journal of ELACTA -  “Lactation & Breastfeeding”
 *
I wish to receive the German paper journal of ELACTA - “Laktation & Stillen”: € 29,-/year/4 issues *
I accept ELACTA Individual membership conditions:
Individual membership conditions
 *
I accept the privacy policy.  *
After we receive your application we will send you an Membership and Cooperation Agreement to sign and pro forma invoice. Your membership will start after paying the membership fee. 
Thank you for being with ELACTA and strengthening the network of IBCLCs in Europe. 
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ELACTA. Report Abuse
Google Forms