APPLICATION FORM FOR ERA-EDTA
YOUNG NEPHROLOGISTS' PLATFORM (Ordinary Members)


I hereby submit my application for the YNP to the European Renal Association - European Dialysis and Transplant Association.
Please fill in all required fields(*) in this application.
Fill in the formFinish
ERA-EDTA Membership Num.*
Title*
Family (Last) Name*
First Name*
Email*
You must be 40 years old, or younger, at the time of applying. If you have not already sent a copy of your picture ID when applying for ERA-EDTA membership, you will have to do this now - see details in the next page.
Birth Date* (day/month/year)
All candidates for Ordinary Membership must have presented at least one scientific paper (as an oral presentation or poster) presented at an international conference held within the previous 3 years.
Title of accepted
presentation*
Name of Congress*
Website*
Venue*
Year*
Presented by the following National Society of Nephrology (if applicable)
*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. Steps have been taken to ensure that consistently high standard of data protection are always in place.
ERA-EDTA YNP Secretariat
Mrs. Muguet Koobasi
Tel.: +32 9 391 95 67
Email: ynp@era-edta.org