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Membership application

There is a growing number of applicants for membership in the SMPA. We are currently processing your data and will contact you soon. Thank you very much for your interest.

Family name:
Given name:
Title(s):
Present work address:
E-mail address:
Phone:
Home address:
Birth date (dd.mm.yyyy):
Place and year where obtained MD:
Place and year where obtained PhD:
Field of research:
I agree with the publication of my name: YES NO
I agree with the publication of my work address
including e-mail address:
YES NO