EuSEM Application Form, both for NEW MEMBERS and for MEMBERSHIP RENEWAL: fill in this form, then proceed with payment (instructions for Bank Draft). - Full member/international member (1 year subscription to EJEM included): 150 € - Associate member (1 year subscription to EJEM included) : 90 € - Eastern Country Member 90 € (with the EJEM) or 10 € (without the EJEM) Important notice: to date, according to the Statutes, only Medical Doctors can apply for EuSEM membership. We'll keep you informed about further developments _ Title First Name Surname Date of birth Nationality Contact address Phone number (including contry and area code) Fax (including contry and area code) e-mail Place of qualification as a doctor Date you qualified as a Medical Doctor: Other qualifications Current field of work Current place of work Special interests Webmaster: Fabrizio La Mura - flamura@mclink.it