top of page

Membership Registration Form

First Name

Last Name

Title

MD

PhD

BS

Others

Date of Birth

Gender

Nationality

Institute Name

Institute Address

Email

Occupation

Category of Membership

Geographical

Please fill the name of a national leader who approved your membership

Reference

Example

Curriculum Vitae (pdf, doc, docx)

Curriculum Vitae

Face photo (jpeg, png, jpg)

Face photo

A recommendation letter from Institutional leader of EAIRDs / the national leader of EAIRDs

A 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 (Signed)

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.

Patient Survey

Patient Survey

Please accept our policy.

I accept terms & conditions

bottom of page