Member application form

Last name
First name
Title
Apply for
Date of birth
Special interest

Work address
Institution
Department
Address
Postal code
City
Country
Telephone
Fax
E-mail

Home address
Address
Postal code
City
Country
Telephone
Fax
E-mail

Please upload your CV including a list of publications

*If it is not possible to submit your information via internet, please contact the scientific secretariat at ECNP + 31 30 253 8567. A printed version of the form will then be made available to you.

All information provided will be treated as confidential.

Print
Send to a friend
Facebook
Twitter