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Membership Application Form

    Please, tick all that applies:


    MANDATORY FIELDS ARE MARKED WITH AN ASTERISK*

    I represent a (please, choose the one that applies)*:

    My organization is:

    Details of the legal representative of your organisation (or of the individual)

    First and last name*

    Position of this person in your organization (if applicable)

    Email address of this person*

    Phone number*

    Address*:

    Zip code*:

    City*:

    Country*:

    The geographical basis for my/our work is*:

    The main purpose of the applicant is*:

    If you chose "other", please specify:

    The applicant is an organisation already member of/affiliated with A NATIONAL umbrella org:

    If yes, please provide the name:

    Does the applicant work or have any commercial interest in companies active in the diagnostic or treatment of cancer (such as, but not limited to pharmaceutical companies, diagnostics, or nutrition companies)?


    PLEASE FILL IN THE FOLLOWING DETAILS OF THE ORGANISATION (if applicable)

    Organisation Name (in English)

    Organisation name (in the original national language)

    Acronym/abbreviation (e.g., CPE)

    General email address

    Telephone number with country code


    DETAILS OF THE PERSON REPRESENTING YOUR ORGANISATION IN CPE (if different from the legal representative)

    First and last name

    Position of this person in your organization

    Email address of this person

    Direct phone number (if possible)