Membership application form International Association of Pediatric Rehabilitologists | NASDR

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Membership application form International Association of Pediatric Rehabilitologists

Full Name:

Date of birth:

Country:

Home address:

E-mail address (required)

Mobile phone number:

Work phone number:

Place of work:

Position held:

Work address:

Overall length of service:

Length of service:

Education:

Name of the educational institution:

Specialty according to certificate:

Academic degree:

Academic title:

What practical result would you personally like to receive from membership in the association?:

Your suggestions for the activities of the association?:

Attach your diploma in PDF format:

I voluntarily submit my data

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