ESHG: Application for Collective membership

Application for Collective Membership

Application / Renewal / Update form for ESHG collective membership

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You are invited to apply for ESHG membership and pay membership dues online:

Membership year from January to December

Collective membership EUR 100.- /year

Collective membership is available to groups of 5 colleagues from selected countries according to the latest available UN List on Economies by per capita GNI.

A group of 5 individuals can register collectively via the online form - 1 main member (A) + 4 affiliate members (B). Collective B members receive all the same rights as regular members other than the right to hold elected positions and to vote.

A group receives access to 1 EJHG online journal (for the Primary Email of A member), but NO print journal. All 5 members are entitled to the reduced registration fee for the European Human Genetics Conferences.

Please enter the A-Member below and submit the B members on the next page.

A-member:

Fields marked with * are required!

Salutation (Mr., Mrs., etc.)

First Name *

Middle Name

Family name *

Academic Title or Position (e.g. MD, PhD, etc.)

Suffix (e.g. Sr., Jr., III, etc.)

Primary Email *

1 ONLINE ACCESS to the European Journal of Human Genetics for the collective group: Please note that the Primary Email is your Username for the online access to the ESHG members area and ONLINE ACCESS to the EJHG for the group. Your Password for the whole group is the ESHG ID of the Collective A member.

Please provide your Institution Information for the Member Directory:

Institution Name

Street Address*

Postal Code *

City *

Country *

Phone *

Fax

Website

YES NO

Invoice Address as given above. *

Please specify Invoice address only if different from the professional address given above:

Name

Street Address

Postal Code

City

Country

YES NO

I agree to be listed in the member directory on the ESHG website (restricted area for ESHG members) with name and work address. *

YES NO

I agree to receive the ESHG Newsletter. *

I have read and agree to the Statutes of the European Society of Human Genetics. I acknowledge that the membership fee is paid in advance for the current membership year and is non-refundable. By becoming a member I acknowledge the ESHG Data Protection Policy. *

Statistical Data Survey among ESHG members

We ask for your gender and the following information to help us provide better and more personalised services to you. Your gender information will be kept confidential and will not be shared with third parties without your consent.

1. Gender *

2. How long have you been working in Genetics? *

3. What is the highest academic degree you have completed? *

4. What are your current activities in Human Genetics? *

5. Which discipline is closest to your primary interest? *

6. In which field(s) of medicine do you have a special interest? *

Payment

Payment method *

Fields marked with * are required!

Application for Collective membership

A-member:

Please provide your Institution Information for the Member Directory:

YES NO Invoice Address as given above. *

YES NO I agree to be listed in the member directory on the ESHG website (restricted area for ESHG members) with name and work address. *

YES NO I agree to receive the ESHG Newsletter. *

Statistical Data Survey among ESHG members

Payment

Membership

YES NO

Invoice Address as given above. *

YES NO

I agree to be listed in the member directory on the ESHG website (restricted area for ESHG members) with name and work address. *

YES NO

I agree to receive the ESHG Newsletter. *