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*:

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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?