Application for membership

Please complete the application form below in full.

This is where you will find the conditions for admission.

If you are applying to become a member of the SAYN, this is where you can download the template for the senior consultant’s letter of support.

Membership

Admission as: *

Personnel

Salutation *

Mrs

Title *

Function in the hospital / practice:

Last name *

First name *

Date of birth *

Language *

Correspondence address

Business or private *

Business

Private

Practice / hospital *

Department *

Address *

Address additive

City *

Zip *

Country *

Telephone *

Website

Information

State exam

State exam year

Specialist

Specialist year

Continuing education

Chief doctor

Title and Name Chief Physician *

Godparenthood

Godparenthood *

Godparenthood E-Mail *

Access data

E-Mail (Login) *

Password *

Repeat Password *

Attachments

CV (PDF, DOC, DOCX) *

Detection Specialist Title (PDF, DOC, DOCX) *

Letter of Support (PDF, DOC, DOCX) *

I have read the Terms and Conditions *

Application for membership

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