EUROPEAN CANCER PREVENTION ORGANIZATION
MEMBERSHIP APPLICATION FORM
Please do not send payment at this time. You will be invoiced at a later date.
Please select one membership type (circle heading):
Open for all academics involved in cancer prevention.
Available to trainees or researchers during the or 3 year immediately following the
completion of the training programme.
Available to nonacademic
health care professionals.
Available to all individuals or organizations that will support the Organization
|Gender: Date of Birth:|
|MD, PhD, other:|
|Degree(s): Please include institution and date granted|
|Training certification/diploma :|
|Start & End date Institution Location Title:|
|Special field in cancer prevention that is applicable for ECP functions and/or|
|Application form should be sent to:|
The European Cancer Prevention Organization
Klein Hilststraat 5 – 3500 Hasselt – Belgium
Tel +3211271557 – Fax +3211283677
We look forward to welcome you as Member of ECP.