Member Application Form

Complete the form below to register your group as a member of ECHDO. All fields marked green must be completed for the form to successfully send.

Basic Info

Tell us about yourself and your group.

Name

Organisation

City

Nation

Telephone (with international prefix)

Web Address

Name of person who will be representing your organisation

Is your organisation a parent organisation or a patient (GUCH) organisation?

Name of registering body for your organisation (in the UK this would be the Charity Comission)

Registration Number

Job Title

Street Address

Postcode

Email Address

Is your organisation the largest/only CHD group in your country?

I agree to hold in confidence any information shared on the ECHDO website or e-mail list that is not already in the public domain (e.g., conference presentations, published literature, Internet content, etc.)
I also agree not to share any information from internal ECHDO discussions (whether in-person, on conference calls, or via e-mail) with other persons who are not ECHDO members, unless authorized to do so by ECHDO leadership or as the result of a group consensus or vote (e.g., as part of a directed group action or work plan).
Finally, I will not disclose personal information that may be shared through ECHDO, such as health conditions/decisions, without express permission of the affected individual. I understand that violations of confidentiality as described herein will result in the termination of my ECHDO membership.

ECHDO Privacy Policy

Complete these fields if you would like to offer a little more information about your group.

How many individuals or member groups does your organisation have?

Do you have any skills or areas of interest that you would like to apply to your work as a member of ECHDO?

Are you human? Read and copy the characters in the display below to prove it!