Membership registration | Fujinamilab

Membership Registration Form

First name

Date of Birth

Middle name

Title

MD

PhD

Bs

Others

Gender

Family name

Nationality

Institute name

Institute Address

E-mail Address

Occupation

Category of Membership

Reference

Please fill the name of national leader who approved your membership

Geographical

Curriculum Vitae

Curriculum Vitae

A recommendation letter from the national leader of EAIRDs

Recommendation letter

If you are keen to be an institutional leader of EAIRDs members (i.e. having ID and Password to access EAIRDs database), please attached a signed research contract form (two signatures by the institutional leader and the national leader). Please download the format here.

Research Contract (Signed)

Research Contract

Patient Survey

Patient Survey

If you are keen to be an institutional leader of EAIRDs members (i.e. having ID and Password to access EAIRDs database), please fill the patient survey sheet. Please download the format here.

Please accept our policy.

I agree to the Terms and Conditions.