GENERAL ASSSEMBLY 2018

I, the undersigned, Dr……

Your First Name (required)

Your Family Name (required)

Registered with the National Order of Physicians

in my country under number

And practising as (specialisation)

at

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Address

Street and n°

City

Zip

Country

Will attend the General Assembly on 20 November 2018

Apply to become a member of the EMA Board of Directors

Apply to become a member of the EMA Scientific Committee

Apply to become an EMA national representative

All candidates have to be in order for their membership fee for two years
Candidates should submit a letter of motivation, a completed application form and a free curriculum vitae of a maximum of three pages.

I agree, if elected, to participate actively in the meetings of the Board of Directors and/or the Executive Board so designated. My candidature relates exclusively to the elections and /or re-elections indicated above.

NB Please complete the application form by 15 September 2018 at the latest
All candidates must have paid their 2018 membership fee

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