Student Application FormTitle* (Ms/Mrs/Mr) First Name *Middle Name Last Name *Institution *Position/Job Title Preferred Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail *Alternative Email Mobile *Upload School I.D/Admission Letter *Please tick the boxes to indicate which Technical Committee(s) you would like to join ConstructionEnergyFinancial ServicesInternational Trade and LogisticsManufacturingSMEsTelecoms, Media, EntertainmentPlease tick the boxes to indicate which Regional Forum(s) you would like to join LACIAC Central African ForumLACIAC East African ForumLACIAC North African ForumLACIAC Southern African ForumLACIAC West African ForumHow did you hear about LACIAC? I confirm that I have read and agree to the Terms of Use and General Information below *I agreeTerms and Conditions 1. MEMBERSHIP APPLICATION Your application to membership shall be accompanied by a personal résumé and be reviewed by our Membership Board Committee. The Committee reserves the right to reject any applications where it is deemed that the applicant does not meet the expected requirements. 2. MEMBERSHIP FEES: CANCELLATION AND REFUNDS 2.1. Membership may be cancelled if, in its discretion, the Membership Committee considers that a current member no longer meets the criteria for membership, for reasons that have become known to the Committee following the approval of membership. 2.2. Such cancellation shall take effect immediately. 2.3. No refunds of membership fee can be issued under any circumstances. 3. USE OF CONTACT INFORMATION 3.1. We may use your information in any of the following ways: a. To notify you about changes to our services; b. To promote our services and activities, including events, training, conferences and newsletters; etc. 3.2. LACIAC will not ordinarily disclose or share your information to third parties except where it is required in the provision of our services to you or as noted in 3.1 above. 4. DIRECTORY OF MEMBERS 4.1. The Membership Directory is a listing of members of LACIAC and includes contact details and such other information as provided to LACIAC. 4.2. Members should note that it is not a listing of arbitrators, nor is it an endorsement of any individual or firm listed, nor of their competence as arbitrator, mediator or neutral. It is also not an indication that the individual listed has at any time, been appointed by LACIAC. 4.3. LACIAC does not warrant the accuracy of any information in the Directory and therefore, under no circumstances or in any way shall LACIAC, its officers, directors, employees, Court members or any other persons otherwise affiliated with LACIAC, be held liable in respect of any information submitted and published on the Membership Directory, and cannot be held responsible for its content and accuracy by any user. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
