Welcome to the ECMTF!

Are you a new member, or are you updating your contact information? *

New member

Member contacts update

Membership form

To show that your organization meets the membership criteria, please complete the following:

We are a voluntary organization/Patients’ Advocacy Group *

Yes

No

Please describe your organization

We advocate for people with Charcot-Marie-Tooth Disease *

Yes

No

Please describe your activity.

Name of the organization *

Charity number

Aims and objectives of your organization *

Name of the President/CEO (main contact for the organization) *

Institutional e-mail address of the President/CEO (main contact for the organization) *

Postal Address of the organization (must include postal or zip code) and City *

Country (organization) *

International Banking Account (IBAN, including SWIFT code) for refunds *

Your Authorized Delegate

Only the individual specified on this form will be able to represent your organization. If your organization’s representative changes, please resend this form with the updated contact details

I am entitled to propose the authorized delegate to the ECMTF and will advise the ECMTF immediately if she/he should cease to be associated with our organization *

I agree

I disagree

If you do not agree with these conditions, we cannot accept the registration

Name of the Authorized Delegate of your Organization at the ECMTF

Name of the delegate *

E-mail address of the delegate *

Postal address of the delegate *

Country *

Your status

You can become a Full Member or an Associate Member. To become a Full Member your organisation must be based in Europe. Only the Delegates of the Full Member organizations will be able to vote at the ECMTF General Assemblies. In order to vote in the president election and on resolutions, your organization must be a properly constituted non-profit organization in your country of origin. Proxies are authorized. All organizations based outside the geographical area of Europe and/or all organizations that are not Patient Advocacy Group can apply to become an Associate Member.

Are you applying as a Full Member or as an Associate Member? *

Full Member

Associate Member

Contribution

The membership fee of €250 gives you the status of Full Member and the right to vote in the General Meetings. It will contribute to all the running costs of ECMTF. It is an annual fee and can be paid by Paypal or via bank transfer. We will send an invoice.

I want to pay the annual contribution *

By Paypal (Please pay by Paypal to the amount of €250 (yearly))

By Bank transfer (Please pay by Bank transfer to BELFIUS Business, IBAN: BE60 0689 0838 0270, BIC: GKCCBEBB the amount of €250 (yearly))

Contribution

The membership fee of €100 gives you the status of Affiliate Member. It will contribute to all the running costs of ECMTF. It is valid for one year and can be paid by Paypal or bank transfer. We will send an invoice.

I want to pay the annual contribution *

By Paypal (Please pay by Paypal to the amount of €100 (yearly))

By Bank transfer (Please pay by Bank transfer to BELFIUS Business, IBAN: BE60 0689 0838 0270, BIC: GKCCBEBB the amount of €100 (yearly))

Change name of the Delegate of the Federation to ECMTF

Enter the details of the new contact person for the ECMTF below.

Name of the organization *

Name of the new Delegate *

E-mail address of the new Delegate *

Postal Address (must include postal or zip code) and city of the new Delegate *

Country *

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Membership form

Your Authorized Delegate

Name of the Authorized Delegate of your Organization at the ECMTF

Your status

Contribution

Contribution

Change name of the Delegate of the Federation to ECMTF

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