Home › User account
Account information
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

APPLICATION FOR EHPBA MEMBERSHIP

EHPBA membership: An applicant for membership shall submit the following electronic application form. Membership commences on payment of the annual dues.

IHBPA EHPBA combined membership: For the application please click here. 

For more information regarding the EHPBA membership please click here.

 

To apply for EHPBA membership, please fill in the following form: 

Personal information

Please select "EHPBA" if you are less than 35 years old or "EHPBA Junior" if you are more than 35 years old.

The content of this field is kept private and will not be shown publicly.

Please provide your EHPBA membership number if you are an existing member. If you do not remember, please leave it blank.

The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.

Please state your academic degress and diplomas such as MD, MSc, PhD, FRCS, etc

The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.

Please provide your Institution's address.

The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.

This is not mandatory.

The content of this field is kept private and will not be shown publicly.

By clicking on the check box, your personal information will be available to all EHPBA members.

The content of this field is kept private and will not be shown publicly.

Please indicate the medical school you graduated from.

The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.

Please indicate the hospital, City/Country, training duration and dates, and type of training. You may add here multiple entries.

The content of this field is kept private and will not be shown publicly.

Such as transplant surgeon, hepatologist, radiologist, general surgeon, etc.

The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.
The content of this field is kept private and will not be shown publicly.

Please indicate the Hospital/University Affilication you are currently employed, the city, country and your actual academic titles. Please use one line per entry.

The content of this field is kept private and will not be shown publicly.

If yes, please indicate here.

The content of this field is kept private and will not be shown publicly.