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Application for membership
New members have to be proposed by two members of the society, one of whom is a member of the Executive Committee. This can take place at any time, with proposals being considered at the next meeting of the Exec. Co. The Executive Committee decides whether the proposed members are acceptable to the society.

The database of members names and addresses is the property of the Society and will be kept by the Secretariat. Members are expected to ensure that an up to date correspondence address is kept with the secretariat. Failure to inform the secretariat of a change of address could lead to loss of membership of the Society.

Any new membership applications shall be supported by two (2) written recommendations: one by a member of the Executive Committee and one by an Ordinary Member of the Society.

Additionally, the applicant is requested to provide a statement from the chairman of an opthalmology department in his/her region (printed on paper with the department's heading and signed by the chairman), which confirms that the candidate is a registered ophthalmologist with an expertise or interest in the field of glaucoma, and that the applicant is a suitable candidate to become a member of the EGS society.


Please use this form to request membership to the European Glaucoma Society (fields marked with * are mandatory):

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Title:
Surname: *
First name: *
Date of birth: * dd -   * mm -   * yyyy
Affiliation: *
Work address: *
Town: *
Postal code: *
Country: *
Your photo:
(max 1Mb - jpg format)
*

CONTACT TELEPHONE NUMBER
Work: *
Home:
Mobile:
Fax:

E-mail address:

*
Secondary e-mail address:

TRAINING DETAILS
 
Resident training (hospital/city/years): *
Fellowship training (hospital/city/supervisor/ years): *
Medical qualifications: *

GLAUCOMA SUBSPECIALITY INTEREST
Please select (min 1 - max 3 interests):
Perimetry
Therapeutics medical
Therapeutics lasers
Therapeutics surgical
Research - clinical
Research - basic science
Imaging
Epidemiology
Genetics
Basic Science
Health Economics
General
Other (specify):



CURRICULUM VITAE (including a photograph)
 
Upload curriculum vitae:
(max 1Mb - doc, docx, txt, pdf or rtf format)
*



LETTER WITH STATEMENT
 
Upload letter:
(max 1Mb - doc, docx, txt, pdf or rtf format)
*



SPONSOR 1 - The first sponsor must be a member of the EGS Executive Committee
 
Title:
Surname: *
First name: *
Position: *
E-mail: *

SPONSOR 2 - The second sponsor must be an Ordinary Member of the Society
 
Title:
Surname: *
First name: *
Position: *
E-mail: *


Additional notes:

Before submitting this form, please type the four characters displayed above:


PLEASE DOUBLE CHECK ALL THE ABOVE AND

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