Membership ApplicationPersonal InformationFirst NameLast NameGenderYour GendermalefemalediversediverseAcademic TitleMembership TypeSupporting MemberDoctor / Medical StudentUniform Continuing Education Number of your Medical Association (EFN) Professional PositionResident DoctorSpecialist DoctorConsultantHead PhysicianGeneral Practitioner (GP)DentistMedical StaffStudentProfessional Position sinceStudies sinceUpload a copy of your medical ID card, professional license, or certificate of medical approbation Select file or drag & drop hereGrößenbeschränkung 5MBErlaubte Typen jpg, jpeg, gif, png, pdfFurther Education and QualificationsThis section does not need to be completed by supporting members. Simply click "Next."Specialist Training / Specialization inSINCE (YYYY)Areas of Interest (multiple selections possible)Work AddressThis section does not need to be completed by supporting members. Just click "Next."Hospital / PracticeDepartmentStreetCityPostal CodePhoneMobile numberFaxE-MailUse as mailing addressPlease confirmHome AddressStreetCityPost CodePhoneMobile numberFaxE-MailUse as mailing addressPlease confirmMembership Fee PaymentMembership is free for students.via SEPA Direct Debit MandateI authorize BHÄG e.V. to collect my annual membership fee from my account via direct debit. At the same time, I instruct my bank to honor the direct debits drawn by BHÄG e.V. from my account. I can request a refund of the debited amount within eight weeks, starting from the date of the debit. The terms and conditions agreed with my bank apply.Name of the PayerAddress of the PayerBank (Name and BIC)IBAN of the PayerPlace, DateSignatureBy InvoiceI will transfer the annual membership fee upon receipt of the invoice.Consent for the Storage and Use of Your Data in Accordance with GDPRConsent to the Statutes of BHÄG e.V.The statutes of BHÄG e.V. are part of this application for supporting membership. I have read and understood the statutes and agree with their content.I consentI consent to the Bosnian-Herzegovinian Medical Association in Germany e.V. (BHÄG e.V.) as the responsible entity processing and using the personal data collected in this membership application—such as name, date of birth, address, email address, phone number, and bank details—exclusively for the purposes of membership management, fee collection, and communication of information by the association. The data will not be used for advertising purposes. Upon termination of membership, personal data will be deleted unless retention is required by law. Each member has the right, under the provisions of the Federal Data Protection Act (BDSG) and the General Data Protection Regulation (GDPR), to access the personal data stored about them by the responsible entity. Furthermore, members have the right to correct any inaccurate data.Private DataI consent to the publication of my non-private data on the forum intranet. I can withdraw this consent at any time within the forum.According to the statutes of BHÄG e.V., the fiscal year corresponds to the calendar year. The membership fee is charged for the period from 01/01 to 31/12 of each year. This also applies if membership in BHÄG e.V. begins during the current year.DateSignature
