Members and Partners
Membership
How to subscribe 


| How to subscribe |
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EMMA is a non-profit (ONLUS) association which maintains a transparent account of its activities. Funding or donations from Industry, Government as well as Individuals help to promote EMMA’s activities. The simplest way to join EMMA is to fill in the Membership Form. If the link does not work, please copy and paste the text below onto your word processor, print and sign it, then fax it to us !!!
EMMA's Membership Application Form FAX TO: Dr Walter ADRIANI, +39 06 495 7821Yes, I wish to apply for membership to European Mind and Metabolism Association (EMMA). Last Name: ……………………………… Birth Date: ............................................. First Name: ……………………………… Birth Place: ….…………….………………………… Degree(s): ……………………………… Job/position title: …………………………………… Department: …………………………………………….…………………………………………… Institution: ……………………………….………………….………………….…………………… Address: ……..……..………………………………………..…………………………….………… City: ………….…………………….…… State/Province: …….….. Zip/Postal Code: …...……… Country: …………………….…………………………………...…….………………………..…… Phone: (include country and area code): …………………...……… ___ Work or ___ Home FAX: (include country and area code): …………………………………....…....……………………... Email: ……………………………………….… Mobile (optional) ……………………………….
I am interested in Bio-Medical Research Interface between Industry and Academia YES/NO I am interested in Clinical Research and Care : Interface of Physicians and Patients YES/NO I am interested in Teaching / Dissemination of Biomedical Culture / Journalism YES/NO
Check the Desired Class of Membership: ____ Regular - Dues: Eur 25.00 Signature: ___________________________ ____ Founder - Dues: Eur 400.00 Signature: ___________________________ ____ Junior Fellow - Dues: (none) Signature: ___________________________ ____ Honorary - Donation: Eur _____________ Signature: ________________________
Please make a check payable to "EMMA - European Mind and Metabolism Association" or a bank transfert to the following account : BARCLAYS - Agency: Roma Fil. 9 - Viale Colli Portuensi 294 – 00151 Roma, ItalyABI: 03051 CAB: 03237 C/C n.: 30160010 IBAN: IT04 X030 5103 2370 0003 0160 010 + SWIFT: BARCITMMBKO
A completed signed form, along with a short curriculum vitae, should be sent to: EMMA’s Treasurer : This e-mail address is being protected from spam bots, you need JavaScript enabled to view it FAX: +39 06 495 7821 For Class Renewal Please Check ____ Date:_______________
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