Membership Application Form ««
Membership Application

Please fill out this form - click the OK-button and follow the instructions.
Fields with  must be filled in.
New membership
Membership renewal

Member No:

 Last Name:
 First Name:
 Title/Position:

 Office/Institution:
 Department:
 Office Address:
 City:
State:
 Postal Code:
 Country:

Tel.:
Fax:
 E-mail:

Home Address:
City:
State:
Postal Code:
Country:

Preferred mailing address:

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MEMBERSHIP FEES

The representative Counsel has established a new membership fee system: In an effort to make it possible for cardiothoracic anaesthesiologist from countries with less stronger economies to become a full member of EACTA the membership fees is from January first graduated based on a gross monthly income.
I am seeking membership as:
Please notice that only Anaesthesiologists can seek full membership

Please notice that new memberships are valid till January 2006/January 2008 (3 Yr)

Payment can be made as follows

JCB - VISA - MasterCard
Bank Transfer

   
Members may be given access to the membership list in a password protected area on the EACTA website. If you do not want your name to appear on that list please notify the membership secretary.
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