Newfoundland and Labrador Association of Career Practitioners

Section 1: Personal Identification

Name:*

Full Address:*

Telephone:*

Telephone (work):

Cell:

Fax:

Email:*

*Notification of the status of your application will be directed to the email address provided.

Website:

Section 2: EMPLOYMENT INFORMATION

Employer Name/Address:

Position:

Position Duties:

Professional Development: (ex. training, workshops, etc.)

Section 3: STUDENT INFORMATION

Name of College/University:

Program of Study:

Year of Study: (1 of 2, 3 of 4)

Section 4: REGISTRATION INFORMATION
Select the appropriate type of membership you are requesting.

Check one:
Practitioner Member ($75)
Associate Member ($50)
Student Member ($25)
Ex-Patriot Member ($35)

Section 5: NLACP CORRESPONDENCE
Periodically, the NLACP will send, via mass mail out, information pertaining to the Association’s activities including newsletters and event notifications. Please indicate your preference for receiving this information below.

Check one:
Yes, please send correspondence regarding NLACP initiatives, including newsletters and event notifications, to my place of employment (please provide complete mailing address and/or email).
No, I do not wish to receive any information regarding the NLACP’s initiatives at my place of employment, but please send to my home address.
I do not wish to receive any correspondence from the NLACP regarding its initiatives.

Section 6: ADDITIONAL INFORMATION
Please provide any additional information you would like us to consider in processing your application:

Section 7: SPECIAL INTERESTS
Throughout the year, the NLACP will provide opportunities for its members to become directly involved in the planning and implementation of various initiatives. By checking the boxes below,your name will be added to the NLACP’s database of potential volunteers. You may be subsequently contacted by an NLACP representative to discuss your interest and availability for participation in specific activities.

Check Area(s) of Interest:
Communications (E-News, Website)
Professional Development
Communications (Press, Advertising, Promotion)
Event Planning
Membership (Membership Drive, Benefits)
Other (Please explain)

Section 8: Consent
I understand that information contained in this application is considered confidential and will be used only by the Newfoundland and Labrador Association of Career Practitioners’ Board of Directors (or any employee of the Association deemed appropriate by the Board of Directors) for the purpose of assessing membership status or for any other purpose as previously described in this application. I hereby give my consent for the sharing of this information for these purposes.

Name in Full:

Date:

Enter verification ID #:

By pressing Submit, you confirm that all your entered information is correct.