If you are an active practitioner of PI, EI, PPI or PEI and would like to be on the ICPIT-List of Active Practitioners,
please fill out the following form.
Your information will be kept in a database by the ICPIT-Secretariat and will only be given to those people in search of a Practitioner.
1. Your name: *
2. Your full address: *
3. Your work address: *
4. Phone number: *
5. Mobile number:
6. E-mail address: *
7. Do you have a website? What is the URL?
8. If you are an active practitioner of any of the following, please tick appropriate box/es: *
9. Who were your ICPIT trainers: *
10. In what year did you receive your certificate signed both by ICRI (Jack Painter) and your ICPIT trainer/s: *
11. Any other relevant qualifications:
12. What is your specialty? Do you work with special issues?