APPLICATION FOR MEMBERSHIP FORM

The Membership Committee :

This is to signify my interest in becoming a member of the International Coach Federation, Philippines Chapter. I
am willing to go through the Application for Membership process, as may be required by the Membership
Committee.

Once a member, I commit myself to actively participate in regular meetings, learning sessions and other activities
of the Chapter. I am also aware that I have financial responsibilities which I promise to pay as soon as they are
due.

Lastly, I will uphold the ICF Code of Ethics and will abide by the rules and regulations of the Chapter at all times.

Sincerely yours,

______________________________________________
Printed Name/Signature/Date

Personal Information
Name (Last, First, M.I.)
Home Address
Organization/Company
Current Position
Telephone Number
Mobile Phone Number
Email Address
Coaching Background (please check boxes)

Current Involvement in
Full-Time Part-time Not Yet
Coaching

ICF-Certified (please
Professional Coaching
indicate: PCC, ACC,
Qualifications
or MCC)
Formally trained
(please specify training
program attended and
Not yet qualified
total # of training
hours):

Coaching Specialization (please check boxes)

Business Coaching
Marketing/Sales Coaching
Start-up Coaching
Personal Development
Coaching
Special Market (specific
professions) Coaching
Corporate/Executive Cross-Cultural Coaching
Coaching
Lifestyle Coaching Marketing/Sales Coaching
Success/Career Coaching People Mgmt & Leadership
Coaching
Quality of Life/Well-being Relationships Coaching
Coaching
Special Skills and Situations Others :
Coaching

Would you like to participate in continuing education programs for Coaches?

Would you like to be a Chapter resource for future learning sessions?

Application for Membership Form

Revised March 2011 Page 1
 Employment History
Inclusive Dates Company Position

Formal Education
Date Graduated Level/Degree Institution/School

I certify that the above information are true and correct to the best of my knowledge. I further authorize ICF
Philippines Chapter or its representatives to verify its correctness as it deems fit.

I also waive any action or complaint that I may have against the Chapter and/or any of its representatives for any
decision that it may take regarding my Application for Membership.

______________________________________________
Printed Name/Signature/Date

For Membership & Screening Committee Use Only

Application for Membership Form
ICF Core Competencies : Self - Assessment
Interview
Approval of Membership
Annual Membership Dues

Application for Membership Form

Revised March 2011 Page 2