LeaderShape Global - LEIPA Facilitator Accreditation Application

Application Form

LEIPA^® Facilitator Accreditation Programme

This application form is for the LEIPA^® Facilitator Accreditation Programme

Payment terms

LEIPA^® Facilitator Accreditation Programme (10 weeks): UK £1,300 (ca. US$1,700 / €1,550)
A non-refundable deposit of £200 ($221 US) deposit secures a cohort place. Once you have completed this application form and subject to availability, we will send you an invoice for the deposit amount. The total amount or the payment schedule (if you have chosen to pay by instalments), will be sent via invoice at least 14 days before the programme commences. Payment may be by PayPal, Credit Card or Bank Transfer.

Required *

Full Name

Date

Address

Zip/Postcode/Area code

Country

Phone (including country code)

Discount code (if applicable)

Are you registered for VAT?

YesNo

How many years coaching experience do you have?

0 - 2 years2 - 5 yearsover 5 years

List any EMCC / ICF /AC or other coaching body credentials you have.

Preferred course start date (type ASAP or month you would like to start)

Sign (type your name)

How would you like to pay?

Total amountInstalments