Membership Application Form



Membership Application Form


Name of your organization:

(in English)


Name of your organization:

(in your national language)


Acronym:

(e.g. NASPA)


When was your organization founded?


Website:


If your membership is accepted, can we add your website and logo to the Euro-HSP website?


E-mail address:


Postal address:




Telephone number:

(with country code)


Organization chairperson / president:



How many people are in your organization?


Can you estimate the number of people living with HSP in your country?





Details of your Euro-HSP Representative:


Name:


Position:


Direct e-mail address (if possible):


Direct telephone (if possible):



Type of organizational membership desired

Full (150 euros)


Associate (0 euros)


Afilliated (0 euros)




The annual fee should be paid to:


Account holder: NASPA

Bank name: DnB Nor

Bank address: Stranden 21, N-0250 Oslo, Norway

Swift: DNBANOKKXXX

IBAN; NO8250820890792



This application form should be filled out and scanned and sent to the secretary of Euro-HSP at marinzap@tiscali.it

Comments