MEMBERSHIP APPLICATION FORM
First Name
*
Middle initial
Last name
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Permanent address
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Telephone
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Address to which Society mail should be sent
if different from above
:
Address
Nationality
Date of birth
Qualifications (including place and date)
Present position
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Special interests
If elected, I agree to abide by the Constitution and By-Laws of the International Society for the Study of Hypertension in Pregnancy.
Signed
______________________
Date
Annual membership dues: € 80,00
IMPORTANT: Please see "ANNUAL DUES STATEMENT" section "WAYS TO PAY"
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