MyMembership > Base Data
Base Data:
Salutation: your salutation
Academic Title(s): your academic title(s)
Degree: your academic degree(s)
First name: your first name
Middle name(s): your middle name(s)
Last name: your lastname/surname
Date of birth: -- e.g. 1965-12-31
Place of birth: city/country
Your eMail: your primary eMail address
Retype your eMail: retype your primary eMail address
Membership Address:
Hospital: Work
Institution: Work
Department: Work
Street: Address for membership
State: US & CA only: 2-letter-code of your state
Phone Number: / / /  
Mobile: / / /  
Fax Number: / / /  
Please note: Fields in red are required.
ESMRMB, Neutorgasse 9, 1010 Vienna, Austria, phone +43 1 535 13 06,,
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