Nurse Specialist Membership Form

Your Information

Family Name *

Please enter your Surname/Last Name

First Name(s) *

Please enter your first name(s)

Job title

Please provide us with your job title

E-mail *

Please enter the email address where we can contact you.

Alternative Email

Please provide an alternative email address (if available)

Institution *

Please provide us with the name of your Institution

Department *

Please provide us with the name of the Department/Unit you work in

Specialty

Adult

Paediatric

Both

Adult / Paediatric / Both

City *

Please enter your city

Post/ZIP Code *

Country *

Website

Please enter the website of your Institution (if available)

About You

Your Nurses Role *

Please tell us a little about your role.

Your Areas of Interest *

Privacy of Information

I allow ECFS to send me communications

I allow ECFS to send me communications *

I agree for ECFS to send me communications by email (e.g. newsletters, communication from ECFS groups and projects, information deemed of interest to members)

I agree to receive communication from third parties

I agree to receive communication from third parties *

I agree to be sent communications from third parties which may be of interest (e.g. call for applications for grants)

I understand that the details above will be sent to the ECFS Nursing Special Interest Group Secretary

I understand that the details above will be sent to the ECFS Nursing Special Interest Group Secretary *

Further information on data protection (in particular on the rights as a data subject to information, objection, revocation of consent, blocking and deletion of personal data) can be found in the ECFS Privacy Policy [1].

Data Protection and Sharing of Contact Details