Application for Registration as a
European Specialist in Laboratory Medicine (EuSpLM)

Please fill in in the online application form. After clicking the application button, a printable version of this form containing your data will be generated. Please print it and follow the instructions at the top of the printed page.

Here you can look up the address of your National Clinical Chemistry Registration Commitee.

Note: Your application will be written directly into the EC4 member database (member status: application pending). For an easy data processing, please fill in the fields carefully: do not mix any field contents (e.g. do not change first and last name), and please do not write your data in capitalized letters (INSTITUTE OF CLINCHEM --> Institute of ClinChem, PARIS --> Paris).

The following countries have been accepted to receive applications – Austria, Belgium, Bulgaria (medical specialists), Czech Republic, Cyprus, Denmark, Estonia (medical specialists), France, Finland, Germany, Greece, Hungary, Ireland, Italy, Latvia (medical specialists), Lithuania (medical specialists), Luxembourg, Netherlands, Poland, Portugal, Romania (medical specialists), Slovenia, Spain, Sweden (medical specialists),
United Kingdom.
The following countries have NOT yet been accepted to receive applications –Bulgaria (scientists), Estonia (scientists), Latvia (scientists), Lithuania (scientists), Malta, Romania (scientists), Slovakia, Sweden (scientists) – please contact your National Representative/NCCRC.

* = mandatory fields

1. Personal Details of Applicant

Title Academic titles only, e.g.:
"Prof. Dr.", "Dr.", "Dr. rer. nat."
(not "Pharmacien", "Biologiste",..)
* First Name "David", "Sarah"
Middle Initials "M.", "William"
* Family   Name "Smith"
Institution, Company

"Hospital de Santo António"
"Université de Paris"
"Laboratoire Medicale B&P"

Department "Central Laboratory"
"Institut für Klinische Chemie"
* Sex   male        female (please select)
* Date of birth   (please select)
* Street

"1, Avenue Charles de Gaulle"
"Königsberger Str. 34"

* Postcode
without country letter (NL, F)
"75016", "NR18 0PD"
* City "Paris", "Wymondham", "Hannover"
* Nationality (please select)
* Country of Residence (please select)
* Telephone Country code "+49"; "+33"
* Telephone

Including area code (without zero)
"441-358674", "9-32-1920-89"

Fax Including area code (without zero)
"441-358674"; "4432-1920-89"
* E-Mail "david.williams@clinical-lab.com"


2. Personal Declaration

Acceptance of the conditions of the EC4 Register is essential for all who seek to join it.You should read the following statement and then sign it to indicate that you understand it and will abide by it:

" I hereby apply to be registered as a European Specialist in Laboratory Medicine. In making this application I affirm that:

  • I have read and understood the 'Guide to the EC4 Register' and the accompanying syllabus
  • I consider my training to meet the minimum standards in the 'Guide to the EC4 Register'.
  • I consider that I am competent to practise as specified in the 'Guide to the EC4 Register'
  • I shall abide by the EC4 Code of Conduct."

 

*  I accept the declaration   


3. Finance

The application fee is 50.00 EUR (£55.00 GBP for applicants from the UK). This fee is non-returnable. If your application is accepted, this fee will also cover registration for a period of five years.

*  

I will transfer 50.00 EUR to the EC4 bank account no.: 515995231
ABN AMRO BANK, PO Box 2059, 3500 Utrecht, The Netherlands
BIC: ABNANL2A
IBAN: NL34ABNA0515995231

[UK applicants only: I will send a cheque for £55.00 GBP payable to the ACB posted to: The Association for Clinical Biochemistry and Laboratory Medicine, 130-132 Tooley Street, London SE1 2TU]  

Credit card payment can not be accepted.

 

Please note: you will not be able to re-enter this page.
Please verify your data carfully and click the button.

Your details will not be saved unless you click the Apply button below!

 

By clicking the button, you agree that EC4 stores your personal data for internal purposes.
These data will not be given to third parties.

Your data will be transmitted to EC4 in SSL encrypted form.

After having received your data, you will see a membership form
with your personal data in HTML file format.
Please print it out and follow the instructions in the file.