Subscription

Your information

Title

Mr

Ms/Mrs

Surname*

First name*

Date of birth*

Profession*

Apartment

Building

Address*

Further info regarding address

Post code*

Town/city*

Country*

Mobile phone number

+33

Personal email address*

Your membership

Membership is a step taken voluntarily by a stakeholder who wishes to go further in their commitment to the MdM community by voting or applying to be a MdM organisational board delegate. Such a person must agree with the ethics of our association and the way it operates. The rules surrounding membership are outlined in articles 4 and 5 of the articles of association as well as in article 1 of the internal rules and regulations.

The annual fee is 35€. You will find all the information concerning the membership fee on your personal member account.

I confirm that I have (or have in the past) been regularly involved in MdM for a period of at least 9 consecutive months.

My status is/was*:

Staff member

Unpaid volunteer

Other

Role within MdM:

As part of the following programme or directorate:

From*:

To:

Have you been a member of MdM in the past?

Yes

No

Please identify the two members who will coopt your membership request. Please type in their names or surnames in order to find them*:

Sponsors 1:

Sponsors 2:

I am an active part of MdM and, if my membership request is approved, I wish to be part of the regional office and receive information about its activities:

Involvement in a group means that:

The regional college may request my presence at the regional assemblies held once every 3 years
The regional college may request my presence at regional meetings and/or may request that I take part in a local initiative
The regional college may send me information (internal newsletters, minutes of meetings, etc.) related to its activities

and/or I am an active member of a geopolitical group and/or of a thematic group and/or of a programme managed by a group and, if my membership request is approved, I wish to be part of the group and receive information about its activities:

Involvement in a thematic group

Environmental health (EH)

Yes

No

Laws Sex and Drugs (LSD)

Yes

No

Migration, Exiles, Rights and Health (MEDS)

Yes

No

Sexual and reproductive health

Yes

No

Involvement in a group means that:

The group may request my presence at elections for the representatives of the groups
The group may contact me to ask me to attend one of the group's meetings and/or to be involved in an initiative
The group may send me information (internal newsletters, minutes of meetings, etc.) related to its activities

I accept to receive, by email, communications from MdM as well as other statutory communications (reminders to pay membership fees, invitations to attend general assemblies, etc.)

I hereby declare that:

I accept the fundamental principles of the Association as well as its mission statement,
I will now, as a member of MdM, make the association's objectives my own. These objectives are outlined in the Statutes
I will not make any public statement about the association without express approval to do so
I will pay my annual tax-deductible membership fee of €35 every year
Paying my membership fees equates to a tacit annual renewal of my commitments as outlined in this form.
I have read the terms and conditions.

*these fields are compulsory