Membership Registration

I wish to become a member and as such have access to all events and website opportunities

Gender

Year of Birth

Title
First Name
Name
Clinic / Institution

Professional Background
Database/IT
Gastroenterology
Genetic Counselling
Medical Genetics
Medical Oncology
Molecular Genetics
Molecular Oncology
Nursing
Pathology
Registry coordination
Research
Surgery
Other:

BUSINESS ADDRESS

Street / P.O. Box

ZIP-Code

City

E-Mail

Repeat E-Mail

Country

Use for Communication
Use for Invoice

PRIVATE ADDRESS

Street / P.P. Box

ZIP-Code

City

E-Mail

Repeat E-Mail

Country

Use for Communication
Use for Invoice

MEMBERSHIP

Membership Fees

(please select your category)

	Clinicians inc. genetic Counsellors, tenured Scientists and Academics	100€
	Students & Junior / non-tenured Academics	50€
	All Others (eg retired: contact us with your personal status)	50€
	Patients / lay Members	25€
	Industry Membership (Please visit Sponsorship)	500€

Membership application deadline: July 1, 2021 for the financial EHTG year

VAT Number

PO Number

(if applicable)

I consent to EHTG and its office holding and using my personal data
to receive conference updates from EHTG and have read the Privacy Policy

This template is made with by Colorlib