ELCA Membership Application PERSONAL INFORMATION: Name: Email Address: Phone Number: Date of Birth: National ID Number: Work Place: Current Position: IBCLC CERTIFICATION: IBCLC ID Card Number: Your Initial certification was in: 199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055 Did you Recertify since your Initial Certification? YesNoNot Due Yet Your Upcoming Re-certification will be in: 20242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055 Your Upcoming Re-certification will be By: CERPsExamNot Sure Participation in ELCA's Activities: I would like to participate in the following ELCA Activity/ies: Clinical activitiesEducational activitiesResearch activitiesSocial ServicesMedia activitiesNational collaborationsInternational collaborationsOthersI do not wish to participate Other Activites: Terms and Conditions Click Here Why Become an ELCA Member Worldwide Recognition Take part in Activities Stay up to date Join the community Special privileges Add your INFO
