Signup form for aspiring members

    Personal information

    Name (required)

    Private address (required)

    Zipcode (required)

    City (required)

    Email (required)

    Phone (required)

    Lægeforeningen manage collection of our annual fee, we therefore need the following information:

    I am a PhD student
    YesNo

    I am a medical doctor
    YesNo

    I wish to receive Scand J. of Immunology (free for members)
    YesNo

    Type of membership
    Student (150,- kr/year)Candidate (300,- kr/year)Company (3000,- kr/year)

    Students and PhD students (check candidate as membership) are free members to next collection of membership fee (June each year)

    Comments


    Company information

    Company Name

    Company Address

    Company Zipcode

    Company City

    Company Phone

    [recaptcha]