APPLICATION FORM FOR MEMBERSHIP

I hereby submit my application for Membership to the European Renal Association - European Dialysis and Transplant Association
Please fill in all required fields(*) in this application.
Fill in the formConfirm your dataFinishMembership Fee payment
Title*
Family (Last) Name*
First Name*
Birth Date
If you are 40 years old or younger, you can pay the junior membership fee.
In this case the birthdate details are mandatory
Place of Birth
Sex
Nationality
Academic Degrees
Present Position
Address for Correspondence*



ZIP Code*
City*
Prov. / State
Country*
Telephone
Fax
Email*
Field(s) of interest* Acute Kidney Injury (AKI)
Basic Science / Immunology / Pathology
Chronic Kidney Disease (CKD)
Clinical Nephrology
Company Consultant
Dialysis
Genetics / Rare Diseases
Hypertension / Diabetes / Cardiovascular Diseases
Nursing
Transplantation
Other (please specify):
(KOSOVO*) This designation is without prejudice to positions on status, and is in line with UNSCR 1244/99 and the ICJ Opinion on the Kosovo declaration of independence.
*The ERA-EDTA collects and processes personal information to provide you with details regarding the Association and its activities. The above information will be published in the ERA-EDTA Directory of members on our website (access to which is restricted to ERA-EDTA members only) and will be used for accounting and commercial purposes by ERA-EDTA and/or Euromeetings s.r.l. in compliance with the Italian Legislative Decree 196/2003. Members can ask that this information be changed, corrected or cancelled at any time by contacting the ERA-EDTA Membership Office where also further information can be obtained. Steps have been taken to ensure that consistently high standard of data protection are always in place. The mailing address and/or e-mail address of ERA-EDTA members may be forwarded to third parties whose services might be of interest to you (only if you check one of the boxes below).
All requests of mailing labels and/or e-mail addresses are, in any case, first approved by an Officer of the ERA-EDTA Council. If you would like to receive information from third parties please tick one of these boxes:
YES, I wish to receive e-mails from third parties;
YES, I wish to receive post from third parties;
ERA-EDTA Membership Office
Via XXIV Maggio 38, I-43123 Parma, Italy
e-mail: membership@era-edta.org