Membership application

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a member

AEPC TEACHING COURSES FOR TRAINEES

Membership application

Please fill out your membership application carefully.

Your membership application will be evaluated following the rules outlined in our policies & procedures.

Your application should be supported by letters of support from 2 AEPC members in good standing. In case you do not know 2 AEPC members to support your application, you will need to upload a recommendation letter from the head of your department/centre or a renowned paediatric cardiologist.

The AEPC Secretary General will inform you about your membership application within a few weeks' time, or if any questions arise from your application.

The fields marked with an asterisk (*) are required fields.

Title
First name* (given name)
Last name* (family name)
Date of birth*
Gender*
Contact email*
Institute
Department
Work street address
Work zip code
Work city
Work country*
Work e-mail
Work phone
Work fax
Work mobile phone
Home street address
Home zip code
Home city
Home country*
Additional e-mail
Home phone
Mobile phone
Membership category
Working groups (membership in one Working Group is included in your membership fee)	Cardiac Dysrhythmias and Electrophysiology Genetics, Basic Science and Myocardial Disease Paediatric Cardiovascular Intensive Care Cardiac Imaging Fetal Cardiology Cardiovascular Morphology Interventional Cardiology Neurodevelopment and Psychosocial Care Congenital Heart Surgery Pulmonary Hypertension, Heart Failure and Transplantation Sports Cardiology, Physical activity and Prevention Nursing and Allied Health Professionals Adult Congenital Heart Disease Task force on clinical (drug) trials
Supporter 1* - Name & email address (or name of head of department & email)
Supporter 1* - Upload the letter of support (a standard letter of support can be downloaded here)
Supporter 2 - Name & email address
Supporter 2 - Upload the letter of support
Upload your CV*
	By submitting this application, I agree that my application details may be shared in order to process my application.*

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