Membership

Registration for institutes

Institute Information

Name of Institute: 

City (location of headquarters):

Country (location of headquarters):

Signer Information

Title:

Gender:

First name:

Surname:

Email: 

Professional Activity / Speciality:

 I hereby sign the Basel Declaration

  I would like to become a Basel Declaration Ambassador

 

I agree for my full name to appear in the public list of signatories:

 Yes

 No

Become a Member

 We wish to become a member of the Basel Declaration Society

 We support the goals and intentions of the Basel Declaration Society

 Please contact us for the yearly membership fee.

Contact person:

Position: 

Street / Number:

ZIP:

City:

Tel. No. :