Membership: Private Area

The EMLTD members have access to exclusive contents.

To access those contents you must be logged as a registered user.

New Membership Form

New Members ONLY

Membership Form for printing

STEP 1/5 STEP 2/5 STEP 3/5 STEP 4/5 STEP 5/5 ACCOUNT DATA * Username * Password * Repeat Password * e-mail If you have already registered, please log in to your Private Area using your username and password and click on Membership - Renewal Fee 2018. Please choose a username and a password. You will need them in your future visits to access the Private Area. Title * Name Middle Name --Dr.Prof.Mr.Mrs.Other * Last Name WORK ADDRESS * Institution/Organization Web Site Department Address Phone # Postal Code City State/Province Fax # Country ACADEMIC DEGREE M.D. Ph.D. D.Sc. Other Current Professional Position FIELD OF WORK Academic Commercial Non-Profit Hospital/Clinic Facility Private Clinical Practice Other PERSONAL DATA Personal Address Personal Phone # Postal Code City State/Province Other Phone # Country UU PAYMENT TERMS & CONDITIONS: Regular Member Annual fee for 2018: 35,00 € BANK TRANSFER (Bank commission will not be accepted) Please fax a copy of the Bank transfer's receipt to the following number: +34 963 942 558 We cannot renew you membership until we receive this proof of payment. BANK INFO: Banco Santander Central Hispano Gran Vía 4º 1ª 48001 Bilbao (Spain) Account number: 0049 1800 13 2710387658 IBAN No. ES63 0049 1800 13 2710387658 SWIFT Code: BSCHESMM CREDIT CARD (No extra fees will be charged) * Holder's name * Credit Card No. * Exp. Date * Safety Code No. Invoice Request * Name * I.D. Tax No. * Address DIRECT BILLING (Domiciliación Bancaria - Spanish residents only) Please fill in all the fields for the direct billing of your membership fee. Once the form has been filled in, please print it out and sent it by fax (+34 963 942 558) or by ordinary mail to the Technical Secretariat: Universidad, 4, 46003 Valencia. * Account Holder's name * Account Number * BANK NAME * Bank Adress * Postal Code/ Zip Code * City * Province/ Estate * Country * I accept terms and conditions You are in a safety area * Marked fields are compulsory

Renewal Fee

“If you want to renew your membership fee, please log in to your private area and click on “New Membership Form” (follow the steps for renewing). If you have any problem, write to secretariat_mltd@geyseco.es”