Membership application

 

You can use this form to apply for membership of EFFECT. Membership is open to all healthcare workers with an interest in electroconvulsive therapy .


Name

First Name

Date of Birth (dd/mm/yyyy)

Profession (psychiatrist, anaesthesiologist, nurse)

Workplace/Hospital Name

Work address

City

Zip code

Country

Email (will serve as user-name)

please pay the annual membership fee directly upon applying for membership to:  

 

Account number:  779590369114
 

Accountholder:  UC St-Jozef, Leuvensesteenweg 517, 3070 Kortenberg (Belgium).
 

IBAN-code:  BE94 7795 9036 9114
 

BIC-code:  GKCCBEBB
 

Bank:  DEXIA, Stationstraat 92, 1930 Zaventem, Belgium.

            Phone +32 2  720.78.05 – Fax +32 2 725.49.75

  

Once the membership fee is paid, you will receive your username and password, to have access to the full EFFECT-website.

 

 

 

Annual membership fee

 

- psychiatrist, anaesthesiologist, nurse, other                                         € 50,-

- trainee                                                                                                   free