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CERTIFICATION APPLICATION FEE FORM

Personal Information: * REQUIRED INFORMATION
*First Name:
*Last Name:
Phone Number:
Fax Number:
*Email:
Location of Evaluation:
 

By submitting this application fee I am certifying that I have completed and submitted all materials required by the Training Standards Commission for IIPA certification.  I also certify that I am a paid up member of the IIPA.
 

I am applying for certification as (check one):

Application Fee: 330 €

Payment can be made by: (please check one)
 

PayPal:

To use PayPal to pay your certification application fee, please submit your Certification Application Fee form and click the PayPal link on the next page. The PayPal site accepts only US Dollar payments.  Please be sure to find the currency conversion rate from euros to US dollars and enter the US Dollar amount on PayPal.
Here is a currency conversion site to give you the exact amount to enter: http://www.xe.com/ucc/


Check or Money Order:

While we will accept checks designated payable in euros, we prefer to receive international money orders for euros payable to: the International Integrative Psychotherapy Association.
Please send the check or money order to Wayne Carpenter, 2902 W. Broadway, #310, Vancouver, BC V6K 2G8 Canada


Credit card:
VISA
Expiration Date:
  MASTERCARD Expiration Date:

Name on credit card:

Account Number:

CVVS Code: (Visa/MasterCard: 3-4 digits at the end of numbers on upper right side of signature strip.)
PLEASE CLICK THE SUBMIT BUTTON ONLY ONCE
It may take a few moments to process your order.
  
For Certification questions contact Helene Cadot at:  helene_cadot@cheerful.com