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Membership Application Form

Thank you for your interest in becoming a member of CPE!

Any not-for-profit organisations, groups, or individuals working for the benefit of cancer patients, wishing to become a member of the association shall address their request to the CPE Board by filling in the following form.

The benefits, rights, and obligations of membership are set forth in the articles of association you can access here.

There are two types of membership:

– FULL MEMBER: they have voting rights at the general assembly. They can be national cancer patient umbrella organisation based in geographical Europe or cancer patients organisations with specific features (article 5.1 of the Statute).

– ASSOCIATE MEMBER: they do not have voting rights at the general assembly. They can be cancer patients organisation not included in the previous case, groups or individuals (article 5.2 of the Statute).

Please refer also to article 5.3 of the Statute for further definitions.

CPE Secretariat is available for further information at secretariat@cancerpatientseurope.org.

    Choose the type of membership you would like to sign/join*

    FULL MEMBER

    Please fill in the following details

    1) ORGANISATION

    Organisation name (in English)*

    Organisation name (in the original national language)*

    Acronym/abbreviation (e.g., CPE)*

    Organisation address*

    Postal code*

    City*

    Country*

    General email address*

    Phone number with country code*

    2) THE LEGAL REPRESENTATIVE OF YOUR ORGANISATION

    Name and surname of the legal representative*

    Position in your organization*

    Please specify:

    Email address of the legal representative*

    Phone number of the legal representative (with country code)*

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

    Name and surname of the representing person

    Position of the representing person in your organization

    Email address of the representing person

    Phone number of the representing person (with country code)

    Aims, activities and geographical basis for your organisation/group

    Please provide a short description of your organisation's aims and activities*

    The organisation is:*

    Please specify:

    The geographical basis for my/our work is:*

    Final declarations

    NOT-FOR-PROFIT - I declare that the organization I represent is a non-profit organization (as
    organization member) / I declare that I have no financial interest in CPE (as individual member)*

    PRIVACY POLICY - The personal information provided on this form will be used by Cancer Patients
    Europe ASBL for the sole purpose of registering your membership. No information will be shared without your consent.
    You can withdraw your information at any time. Please refer to CPE Privacy Policy:
    https://cancerpatientseurope.org/privacy-policy/*

    WEBSITE CONTENT - By completing this form I consent the unremunerated use of the given data by
    Cancer Patients Europe, for the purpose of updating the website members' page

    MEMBERS' NEWSLETTER -  I accept CPE keeps me informed on its activities via its newsletter*

    ASSOCIATE MEMBER

    After selecting the type of entity you are, please fill in the requested details

    I am*

    Organisations or Groups

    1) ORGANISATION/GROUP

    Organisation/Group name (in English)*

    Organisation/Group name (in the original national language)*

    Acronym/abbreviation (e.g., CPE)*

    Address*

    Postal code*

    City*

    Country*

    General email address*

    Phone number with country code*

    2) THE LEGAL REPRESENTATIVE OF YOUR ORGANISATION/GROUP

    Name and surname of the legal representative*

    Position of this person in your organization/group (if applicable)*

    Email address of this person

    Phone number with country code*

    3) THE PERSON REPRESENTING YOUR ORGANISATION/GROUP IN CPE (if different from the legal
    representative)

    First and last name

    Position of this person in your organization/group

    Email address of this person

    Phone number with country code (if possible)

    Aims, activities and geographical basis for your organisation/group

    Please provide a short description of your organisation's aims and activities*

    The organisation is:*

    Please specify:

    The geographical basis for my/our work is:*

    Final declarations

    NOT-FOR-PROFIT - I declare that the organization I represent is a non-profit organization (as
    organization member) / I declare that I have no financial interest in CPE (as individual member)*

    PRIVACY POLICY - The personal information provided on this form will be used by Cancer Patients
    Europe ASBL for the sole purpose of registering your membership. No information will be shared without your consent.
    You can withdraw your information at any time. Please refer to CPE Privacy Policy:
    https://cancerpatientseurope.org/privacy-policy/*

    WEBSITE CONTENT - By completing this form I consent the unremunerated use of the given data by
    Cancer Patients Europe, for the purpose of updating the website members' page

    MEMBERS' NEWSLETTER -  I accept CPE keeps me informed on its activities via its newsletter*

    YOUR PERSONAL DATA

    Name and Surname*

    Date of birth*

    Your affiliation (if any)

    Address (street, postal code, city)*

    Country*

    Email*

    Phone number with country code*

    I am*

    Please specify:

    Final declarations

    NOT-FOR-PROFIT - I declare that the organization I represent is a non-profit organization (as
    organization member) / I declare that I have no financial interest in CPE (as individual member)*

    PRIVACY POLICY - The personal information provided on this form will be used by Cancer Patients
    Europe ASBL for the sole purpose of registering your membership. No information will be shared without your consent.
    You can withdraw your information at any time. Please refer to CPE Privacy Policy:
    https://cancerpatientseurope.org/privacy-policy/*

    WEBSITE CONTENT - By completing this form I consent the unremunerated use of the given data by
    Cancer Patients Europe, for the purpose of updating the website members' page

    MEMBERS' NEWSLETTER -  I accept CPE keeps me informed on its activities via its newsletter*