EACME Application Form

Medical ethics centers/institutions located in-/outside Europe can become full members of EACME. If you are an individual working in medical ethics you can apply to be an associate member. If you would like to discuss your application before submission please contact the EACME Executive Board Secretary, Kim Zandvliet.

Full name of Centre*

Chairperson of the Centre

Address*

Website*

Telephone*

Email*

Institute (if any)

Legal status of centre or institution*

Your centre's involvement in the field of medical ethics

Please note that this application is expected to show the activities in bioethics of the centre  on behalf of which you are applying, and is not intended as a personal application on behalf of any individual. Therefore, do not submit documents relating to personal expertise which are not relevant as far as the centre is concerned.

Please detail the experience of the centre in the field of medical ethics*

Please detail the collaborative works your centre has been involved in including your main scientific partners*

Please detail the contributions to research that your centre has made. Indicate if the centre is, or was, holder of any project of research in bioethics - in which case indicate the commissioners*

Indicate publications published or edited by the centre, and recent articles published in scientific journals signed by the staff of the centre*

Additional Information

Select the membership type your centre is applying for
Full membership (€350 pa)Associate membership (€150 pa)Full membership LMI-countries* (€200 pa)Associate membership LMI-countries* (€75 pa)

Date of Application*

Authorised person*

Position within the organisation*

Please attach supporting documents here. If they exceed the 2mb file limit please email k.oerlemans@amsterdamumc.nl directly and specify your centre name in the subject field.

If you would like to share a link to supporting documents please enter it here

* EACME will offer a reduced EACME membership rate for low and middle-income countries (based on the yearly EOCD list). The reduced rate will be € 200 for a full membership and € 75 for an associate membership. EACME will automatically offer this for new members; existing members have to apply for it if they want to make use of the reduced rate.

I confirm that I have the authority to submit this application on behalf of the centre and once the application has been processed and accepted by the EACME payment in full will be provided within 7 days of invoice.