KPI Practitioner Application Form

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KPI Practitioner Certification Application Form

APPLICANT INFORMATION First Name Last Name Job title Organization Address City Country Phone number E-mail address* Organization website * Provide an active email address to ensure you receive all communications, including notifications, acknowledgments of receipt, reminders, results, certificate and Letter of Acknowledgement. REGISTRATION DETAILS Date of submission of Application Form Planned date of submission of Application Portfolio* * The date you plan to submit you Application Portfolio PAYMENT Applicable fee: Standard certification fee: $500 Fee for applicants who register within 3 months from the date of obtaining KPI Professional certification: $400 Fee for applicants who have completed the Certified KPI Practitioner preparation course: $300 Reassessment* fee: $200 I have a Certified KPI Practitioner Evaluation Voucher** * Reassessment: review for the second time or more of the application portfolio ** Applicable for participants from Informa (formerly known as IIR Middle East) Payment option Bank transfer Credit card LETTER OF ACKNOWLEDGEMENT Select if you want to receive a Letter of Acknowledgement: Yes, addressed to … Yes, standard (‘To Whom It May Concern’) No, I do not want to receive a Letter of Acknowledgement

www.kpiinstitute.org office@kpiinstitute.org +61 3 9028 2223

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