ODPN Membership Application Form

Membership Application Form
Organization Development Practitioners Network, Inc. (ODPN) respects your privacy and will keep secure and confidential all personal and sensitive information that you may provide in this membership application form.
Date of Application

Month Day Year
Date
Membership Type *

Individual Membership (You are applying as an individual OD practitioner.) Php2,500.00 Corporate Membership (You are applying as a Corporate Primary Representative for your OD practitioners in the company.) Php5,000.00
Name *

Prefix First Name Middle Name Last Name
Date of Birth *

Month Day Year
Date
Gender

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
example@example.com
Cellular Number *

Area Code Phone Number
Please check the applicable box, if you are working: *

as an Independent HR or OD consultant in a company
If an Independent HR/OD Consultant, how long have you been one?
If you are working in a company, please answer questions A - H:
A. Name of Company
B. Company Address
C. Company Phone Number

Area Code Phone Number
D. Your Position in the Company
E. No. of Years in the Company
F. Industry/Nature of Business
G. Do you have an OD Division or Department?
H. If you are not the same person, please give the name of your HR or OD head and the official position/title
Total No. of Years in OD
Are you willing to be a member in any of the Organization's committees? If yes, please check your preference:

Branding Membership Programs Partnerships Ways and Means
I certify that all information in this application is true and correct. I hereby allow ODPN to investigate all details made in this application and authorize ODPN to have access to and to use the same details for administrative purposes.
Signature

Clear
Signature Date

Month Day Year
Date
IMPORTANT NOTES:

1. Due to the prevailing situation, we can only accept payments via bank deposit or bank transfer to:
Bank: Bank of the Philippine Islands or BPI
Account Name: Organization Devt. Practitioners Network
Account #: 3201-0394-19

Please send a copy of the deposit slip or bank transfer as proof of payment to odpnsecretariat@gmail.com.

2. We can only send Statements of Account (if needed) and Official Receipts via email. Should you need an original copy of either, we will ask you to please handle the courier charges or get them in the next session, when participation can be in person.

3. Corporate Members are allowed 3 members free for OD Conversations for 2020. They will have to inform the ODPN Secretariat the names of the 3 official participants to the session. Additional participants can join at Php500 per participant.
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm