EACME Application Form

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)

Date of Application*

Authorised person*

Position within the organisation*

Please attach supporting documents here. If they exceed the 2mb file limit please email a.heijnen@maastrichtuniversity.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

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.