ESPRM - Europea Society of Physical and Rehabilitation Medicine

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APPLICATION FORM FOR INDIVIDUAL MEMBERS TO
EUROPEAN SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE

Dear colleague,

European Society of Physical and Rehabilitation Medicine is open to all European qualified physicians, specialised or candidates in physical and rehabilitation medicine who have the interest and will to actively support ESPRM and its activities.
The goals of the ESPRM are: to facilitate international exchange regarding different aspects of rehabilitation research, including disseminating information about rehabilitation related funding, multicentre trials, national and European projects, meetings and congresses; to provide means to facilitate research activities and communications at the European level; to organise a biannual European congress of PRM in one of the member countries; to influence national governments and European organizations to support initiatives and co-operation in the fields of research in PRM; to establish a close co-operation with the UEMS, the European Section and Board of Physical and Rehabilitation Medicine and the Académie de Médecine physique et de Réadaptation, and to provide information to local, national and European governments about the contents and evidence based efficacy of P&RM.
The mission of the ESPRM is to be the leading scientific European Society for physicians in the field of physical and rehabilitation medicine and to improve the knowledge of fundamentals and the management of activities, participation and contextual factors of people with a disability.
Individual members will be entitled to nominate 3 of their representatives to the Board of Governors and will have the right to vote and to hold office. Each individual member is eligible to be elected to any position of the Executive Committee, the Board of Governors, to attend meetings and other activities of the ESPRM.
Further benefit to be an individual member.

- Possibility to send article to the site
- Access to a reserved area of the site

In order to become an individual member to ESPRM please fill in the following form. Mandatory data are signed with an asterix (*).

If you are already registered but forgot the password please click here.

Email (*)
It is necessary to indicate a valid email address where you will receive the communication and the newsletter if required.

Password (*)
Type your personal password. The password must be at least 5 characters long.

Password confirmation (*)
Please type your password again.

Surname (*)

Name (*)

Organization (*)

Address (*)
Please type the address of your office or of your preferred contact location.

City (*)

ZIP code (*)

Country (*)

Telephone

Fax

Specialist or trainee in Physical and Rehabilitation Medicine (*)
Yes       No

Presented by the president of National PRM society
Name

In alternative, please add the names and the emails of two colleagues (Board of Governors members) who could verify your position in Physical and Rehabilitation Medicine
Name 1     Email 1
Name 2     Email 2

Place of work
Rehabilitation Hospital
General Hospital
Community Rehabilitation facilities
Only private practice
Other

Other information
If necessary, please provide other information related to the registration process (payment reference, etc. )

Newsletter
Check if you wish to receive the ESPRM newsletter.

Statement on the Privacy
Information based on the Italian law "art. 13 Decreto Legislativo 196/2003".

Informativa per trattamento di dati ai sensi e per gli effetti di cui all'articolo 13, D.Lgs 30/06/2003 n.196. In osservanza di quanto previsto dal D.Lgs 30.06.2003 n.196, ESPRM in qualità di titolare del trattamento, viene a fornirLe le dovute informazione in ordine alle finalità e modalità del trattamento dei Suoi dati personali, nonché l'ambito di comunicazione e diffusione degli stessi, alla natura dei dati in nostro possesso e del loro conferimento.

FINALITÀ DEL TRATTAMENTO 
						Il trattamento dei dati personali è effettuato da ESPRM esclusivamente per i seguenti scopi:
						- Fornire i servizi richiesti.
						- Effettuare indagini di mercato e studi di marketing.
						- Fornire informazioni e/o offerte su prodotti, servizi o iniziative promosse da ESPRM o da suoi sponsor (partner commerciali), senza che ciò determini la cessione dei dati stessi a soggetti terzi.	
						- Collaborazione con Le competenti Autorità Giudiziarie per finalità inerenti alla prevenzione e repressione dei reati.

MODALITA' E DURATA DEL TRATTAMENTO
						I dati come sopra specificati e raccolti sono conservati su supporto informatico. Lei può cancellare i dati, in qualsiasi momento e senza intermediazione, autonomamente e sotto la propria responsabilità, attraverso una procedura automatizzata online messa a disposizione da ESPRM.
						I dati sono trattati all'interno della società, dai collaboratori e dai dipendenti che sono stati designati responsabili e/o incaricati del trattamento e che hanno ricevuto le necessarie ed adeguate informazioni in materia. Il trattamento dei Suoi dati viene effettuato in modo lecito e secondo correttezza, per scopi determinati, espliciti e legittimi, non eccedenti rispetto alle finalità.

NATURA DEL CONFERIMENTO
						La informiamo che la comunicazione dei dati è necessaria ai fini dell'adempimento dei servizi richiesti; il mancato conferimento, così come il conferimento parziale o inesatto, ha come conseguenza di impedire l'erogazione puntuale del servizio.

Agreement (*)
I agree with the terms set above.

Security code (*)
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