Membership

Registration for individuals

Sign the Basel Declaration

Title:

Gender:

First name:

Surname:

Name of Institute:

 My Institute is member of the Basel Declaration

Email:

City of residence:

Country: 

Professional Activity / Speciality:

 I hereby sign the Basel Declaration

 I would like to become a Basel Declaration Ambassador

 

 I agree for my full name to appear in the public list of signatories:

Yes

 No

 

Become a Member

 I wish to become a member of the Basel Declaration Society

 I support the goals and intentions of the Basel Declaration Society

 I agree to the current yearly membership fee of 50 sfr / euros / dollars

Street / Number:

ZIP:

City:

Tel. No. :