Whole Group Annual Verification

As the contact person for my Practice Group, I understand that Whole Group status means that each member of our Practice Group must maintain membership in good standing with IACP, thereby entitling all of our members to a discounted IACP membership rate. We will ensure that all of our members comply with this requirement and will inform new members to our group of this requirement immediately upon joining. I will keep IACP apprised of any changes to our membership roster, including changes to our contact person. We understand that if our members fail to maintain IACP membership in good standing, our Whole Group designation will be terminated.

Membership *

Verified for Whole Group Discount

Total Amount

Verification on Behalf of

Whole Group Name *

Main Office Phone Line *

Email (General Office Inbox) *

Please enter the 'generic' email box for your office, not your personal address.

Country *

Street Address *

City *

State/Province

ZIP/Post Code *

How many practitioners comprise your Whole Group? *

How many of your Whole Group practitioners are IACP members? *

Please provide a current roster of ALL of your practitioners and their email addresses. You may copy and paste them into the text box, or you can upload a file below. Excel file preferred, please.

Optional roster upload

A full list of current members' names & email addresses *

Who has left the group recently?

Contact Person for this Organization

First Name *

Last Name *

Email *

Job Title