Membership Registration

Membership registration form

Title*
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First Name*
Please let us know your name.

Surname*
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Gender*
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Phone*
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Mobile phone
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Email is also used as username and a confirmation email is sent to this email address.
Email*
This email address is already in use!

Email (Check)*
The two email adresses mus be the same

Password*
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Password (Check)*
The two password entries mus be the same

Organisation

Unit
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Address
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City
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Country
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Postal Code
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Type of organisation*
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Other*
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Area of interest*
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Other*
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Maximum of 5 key words for personal profile can be added.
Keyword 1
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Keyword 2
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Keyword 3
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Keyword 4
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Keyword 5
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Membership Category*
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Upload copy of student card (only for MSc & BSc students)*
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Presence recent ERSCP Conferences*
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