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Join EUSOMA

Individual subscription to Eusoma membership and journals is on annual basis (calendar year: beginning Jan. 1st and ending Dec. 31st)

Please complete the following form.

All fields marked with an asterisk (*) must be completed

Personal data

Title:
*Last Name:
*First Name:
*Gender:
*Birth date:
*Institution:
*Position:
*Working field:
Department:
Hospital:
*Address:
*Post Code:
*City:
*Country:
*Email:
*Telephone:
Fax:
Mobile:

Directory

I give my permission to Eusoma to put my personal details in the members directory on the members only site of www.eusoma.org. I understand that other Eusoma members will be able to view these data.
I give my permission to Eusoma to show my email address in the members directory on the members only site of www.eusoma.org. I understand that other Eusoma members will be able to view my email address.

Security

*User name:
*Password:
min 8 and max 50 characters
*Confirm Password:

Privacy

I have read and agree the Terms & Conditions*
Privacy

2024 MEMBERSHIP FEE

only membership € 50
membership and journals: EJC (print and online) € 175
membership and journals: EJC (only online) € 130

I wish to receive the journal at a different address from that indicated above

*Address:
*Post Code:
*City:
*Country:

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