INTERNATIONAL FEDERATION OF PROFESSIONAL MANAGERS CHRP Membership Application PERSONAL DATA Mr./Ms./Mrs./Miss/Dr. * Surname * First Name * Middle Name * Suffix Date of Birth: * Gender * MaleFemale CONTACT INFORMATION HOME MAILING ADDRESS Home / Bldg. No., Street * City * Province * Postal Code * Phone Number * Mobile Number * Personal E-mail Address * BUSINESS MAILING ADDRESS Position Company Name Unit/Bldg. No., Street City Province Postal Code Phone Number Fax Number E-mail Address EDUCATION & PROFESSIONAL INFORMATION BACHELOR’S DEGREE Course University Year MASTERAL / DOCTORAL Course University Year OTHER Course University Year License No. Year FEES Certification Package Php 7,500 Via courier with additional fee of Php 300 Preferred mailing address: *HomeBusiness PROOF OF PAYMENT Make sure to upload *Scanned Copy or Screenshot of your VALIDATED Proof of Payment with transaction details such as Date of Transaction, Payment Reference no., Amount Paid, Bank Account no. (should be visible) *Upload your file here (File name must be: Surname_FirstName): DATA PRIVACY Upon signing this form you are agreeing that the personal data obtained from the registration form entered and stored within the Institute’s authorized information and communications system and will only be accessed by the IFPM authorized personnel. Furthermore, the information collected and stored in this form shall only be used for the following purposes: Announcements / promotions of events, programs, courses and other activitiesoffered / organized by the Institute and its partners; Activities pertaining to establishing relations with participants/members/alumni; IFPM Philippines has the right to share your information to our related affiliate companies, institutions, and or subsidiaries; IFPM Philippines shall not disclose the participants/members/alumni personal information without their consent and shall retain this information over a period of ten years for effective implementation, research analytics, and management. ACCEPTANCE OF SUBSCRIPTION I declare that all of the information contained in this application is true and correct and I agree to provide any supporting documentation requested by the Institute. If accepted, I agree to abide by the International Federation of Professional Managers’ Code of Professional Conduct and Continuing Professional Education requirements. I understand that I must renew my subscription annually to enjoy the services provided by the Institute including eligibility privileges and retention of professional designation. Yes, I accept Digital Signature * Date Signed * Please double check your PERSONAL EMAIL if entered correctly before submitting the form. Confirmation email will be sent there.