Membership Application

First Name

Last Name

Gender

diverse

Academic Title

Membership Type

Supporting MemberDoctor / Medical Student

Uniform Continuing Education Number of your Medical Association (EFN)

Professional Position since

Studies since

Upload a copy of your medical ID card, professional license, or certificate of medical approbation

Select file or drag & drop here

Größenbeschränkung 5MBErlaubte Typen jpg, jpeg, gif, png, pdf

This section does not need to be completed by supporting members. Simply click "Next."

Specialist Training / Specialization in

SINCE (YYYY)

Areas of Interest (multiple selections possible)

This section does not need to be completed by supporting members. Just click "Next."

Hospital / Practice

Department

Street

City

Postal Code

Phone

Mobile number

Fax

E-Mail

Use as mailing address

Please confirm

Street

City

Post Code

Phone

Mobile number

Fax

E-Mail

Use as mailing address

Please confirm

Membership is free for students.

via SEPA Direct Debit Mandate

I 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 Payer

Address of the Payer

Bank (Name and BIC)

IBAN of the Payer

Place, Date

Signature

By Invoice

I will transfer the annual membership fee upon receipt of the invoice.

Consent 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 consent

I 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 Data

I 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.

Date

Signature

Membership Application

Personal Information

Further Education and Qualifications

Work Address

Home Address

Membership Fee Payment

Consent for the Storage and Use of Your Data in Accordance with GDPR