APPLICATION FORM FOR CORPORATE MEMBER

(all companies recognised under public or private law, involved in activities or share responsibilities compatible with EMA)

Company

Annual membership fee : 5.000,00 €

IBAN Code : BE98 2100 6246 2493 – BIC : GEBABEBB

Company name (acronym & full) (required)

Address (required)

Country(required)

Phone Nr (required)

Website

Category (required)

Legal representative

MrMrsMissMs

Last name (required)
First name (required)
Position (required)
Address (required)

Phone Nr (required)

Email (required)

I agree to become a full Corporate Member of the European Medical Association (E.M.A.) and to abide by its statutes.

I have read our privacy policy [/ acceptance]