Federation Assembly

Federation Assembly membership form.

Application for a neurointervention society to become a member society of the WFITN Federation Assembly. Membership is free of charge. Please name at least one delegate and an administrator and attach the constitution of your society.

Application

Apply for membership.

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Society
Name of Neurointervention Society*
Number of members
Year society constituted
Country of registration
Delegates
Delegate 1 is mandatory. Delegate 2 and an alternate are optional.
Delegate 1 name*
Delegate 1 email*
Delegate 1 phone number*
Delegate 2 name
Delegate 2 email
Delegate 2 phone number
Alternate name
Alternate email
Alternate phone number
Administrator
Administrator name*
Administrator email*
Administrator phone number*
Declaration
Name of person completing form*
Position in Society*
Date*
Society constitution file*
Accepted file types: pdf, doc, docx, Max. file size: 10 MB.

PDF or Word document, max. 10 MB.
Declaration*
I confirm that I am authorised by the society named above to apply for membership of the WFITN Federation Assembly and that the information given is correct.
Privacy consent*
I have read the privacy policy and agree that the details given are used to process this application.

What we need

Name, size, founding year and country of your society
Delegate 1 with email and phone (delegate 2 and an alternate are optional)
An administrator as the contact for the Secretariat
The constitution of your society as PDF or Word file

Questions

secretary@wfitn.org

Back to the Federation Assembly

* Required fields.

Federation Assembly membership form.

Apply for membership.

Society

Delegates

Administrator

Declaration

What we need

Questions