Become a member


Fill the form to join LapCI ry or when you want to update your membership information. Fields marked with an asterisk (*) are mandatory.

    I want to join LapCI ry or update my information*:

    LapCI membership (25 € / year)I am already a member, I would like to update my information

    Name*:

    E-mail*:

    Street address*:

    Postal code*:

    City*:

    Phone*:

    Second parent/guardian

    Name:

    E-mail:

    Information of the CI-child

    Name*:

    Date of birth*:

    Where the first cochlear implant was fitted*?

    When was the first cochlear implant fitted (date)?

    The first cochlear implant's brand and type*?

    Where the second cochlear implant was fitted?

    When was the second cochlear implant fitted (date)?

    The second cochlear implant's brand and type?

    Where did you hear about LapCI ry*?

    If other, where?