Swiss MD-PhD Association: 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