1

Contact details

Company / Organisation
UID / VAT
Salutation
Title, academic grade
First name
Last name
Date of birth
Department
Position in the company
2

Adress data (invoice data)

Street, no.
Zip code, city
Country
3

Contact data

Phone
Mobile
Fax
Email
Website
Recruited by (IAPA ID)
4

Add facility

Please use the following function to enter your ropes courses and facilities. Up to six addresses (facilities) can be entered.

6

I hereby apply for IAPA membership.

The fees listed are annual fees. All fees are excluding VAT. As of June 2020

Active Membership

Passive Membership

7

SEPA direct debit mandate

Bank
Account holder
IBAN
BIC
8

Data protection / Declaration of consent

I confirm that the above information is true and correct and grant permission to collect the SEPA direct debit for the selected fee.

The fields highlighted in colour are mandatory fields.
 
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