Membership registration

First name:
Family name:
Titles:
Email:
Date of Birth:
dd.mm.YYYY
Mailing address:
Postal Code:
Phone:
Mobile phone:
Institution:
Address:
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Fax:
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I apply as a full member of the Czech Society for Ultrasound in Obstetrics and Gynecology CzMA JEP. I agree with the mission and objectives of the Society and I am not in debt to the CzMA and its organizational components.
The application form is personal information only for our communication.
I agree to receive information by e-mail
(Czech Law No.480/2004)