Rejestracja – Polskie Stowarzyszenie NDT-BOBATH

Formularz rejestracji członka stowarzyszenia

Wypełnij formularz i dołącz do naszego Stowarzyszenia !

Członkiem Stowarzyszenia może zostać osoba,
która ukończyła kurs podstawowy NDT Bobath

- Imię* Imię
- Nazwisko* Nazwisko
- E-mail* E-mail*
- Telefon* Wymagany format numeru telefonu:###-###-###
- Zawód*
  - Fizjoterapeuta
  - Logopeda
  - Terapeuta zajęciowy
  - Lekarz
  - Neurologopeda
- Tytuł naukowy, dyplom* Tytuł naukowy, dyplom*
- Ukończone kursy specjalistyczne* Ukończone kursy specjalistyczne (miejsce, data, nazwa kursu, prowadzący)*
- Certyfikat NDT-Bobath*
  Plik w formacie jpg, png lub pdf
- Dyplom uczelni*
  Plik w formacie jpg, png lub pdf
- Internetowa lista terapeutów*
  - Tak
  - Nie
  Jestem zainteresowany(a) umieszczeniem moich danych osobowych (miejsce pracy) na internetowej liście certyfikowanych terapeutów
- Kraj* Wybierz kraj działalności*
- Miasto* Miasto prowadzenia działalności*
- Strona www Strona www
- O mnie O mnie, opis działalności, kariera zawodowa itp
- Hasło* Minimum length of 6 characters.
  Hasło musi posiadać następujący minimalny poziom skomplikowania: słabeSiłomierz
- Powtórz hasło*
- reCAPTCHA*
- Członkostwo
  Członkostwo - 60,00zł /
  Roczna opłata członkowska
  Automatycznie przedłuż subskrypcję
  Będziesz mógł dokończyć płatność po potwierdzeniu swojego adresu e-mail.

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