EUROPEAN SOCIETY FOR HEALTH AND MEDICAL SOCIOLOGY

MEMBERSHIP APPLICATION FORM

Please complete this form electronically and send it automatically to the 

Secretary/Treasurer, Prof Michèle Baumann, at the following e-mail address:

michele.baumann@uni.lu

OR Print the form, complete and post with a cheque (in euros) made payable to Prof Michèle

Baumann (Secretary/Treasurer): 

Michèle BAUMANN
a.Professeure sociologie de la santé
Université du Luxembourg
Faculté LSHASE

Laboratoire INSIDE
B.P. 2
L-7201 Walferdange

Application for ESHMS Membership or Renewal of ESHMS Membership

 I wish to apply for membership of the society and enclose/attach an electronic version

      of my Curriculum Vitae:

 I wish to apply for/renew membership in the Society and enclose/attach an up to date

      electroinc version of my Curriculum Vitae

We encourage you to support our Society by joining for a 2-year period to coincide with our Congress

cycle and ensure that you receive early notification of the next Congress and any seminars/workshops.

Only  those   individuals  who  have  paid  their  ESHMS  Membership   Fee  will  qualify for the reduced

registration fee.  

Please indicate which option you require:

Full 2 years' membership fees:      

o  Western European countries:           	€ 50.00 (fifty euros)      

o  Eastern European countries:            	€ 30.00 (thirty euros)   

o  Full student member(general/PhD):   	€ 30.00 (thirty euros)           

One year period membership fees:

                  o  Western European countries:          € 25.00 (twenty five euros)

                  o  Eastern European countries:           € 15.00 (fifteen euros)  

                  o  Full student member(general/PhD):  € 15.00 (fifteen euros)         

I will transfer the sum of     euros to the following account:

Name: Prof. Siegfried Geyer

Bank: BB- Bank Karlsruhe/ Germany 

Sort Code: BIC GENODE61BBB

IBAN DE77660908000011618482