Member Application Form

View Article 4 on articles of association for more information

Membership *

Applying for active membership

Applying for associated membership

Organisation *

Street address *

City *

Postal code *

Nation *

Telephone number *

Organisation's e-mail address *

Web address

Name *

Job title *

E-mail address *

Telephone number *

Is your organisation only CHD group in your country? *

Yes

Is your organisation the only CHD group in your country *

Yes

Is your organisation a parent organisation or a patient (GUCH) organisation? *

Parent organisation

Patient (GUCH) organisation

Both parent and patient organisation

Name of registering body for your organisation *

Registration number *

Complete these fields if you would like to offer a little more information about your group.

How many individuals does your organisation have?

How many member groups does your organisation have?

Do you have any skills or areas of interest that you would like to apply to your work as a member of ECHDO?

Additional information

- I agree to hold in confidence any information shared on the ECHDO website or e-mail list that is not already in the public domain (e.g., conference presentations, published literature, Internet content, etc.) I also agree not to share any information from internal ECHDO discussions (whether in-person, on conference calls, or via e-mail) with other persons who are not ECHDO members, unless authorized to do so by ECHDO leadership or as the result of a group consensus or vote (e.g., as part of a directed group action or work plan). Finally, I will not disclose personal information that may be shared through ECHDO, such as health conditions/decisions, without express permission of the affected individual. I understand that violations of confidentiality as described herein will result in the termination of my ECHDO membership.

Agreement of the privacy policy *

I agree

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