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Application
for Registration as a
European Specialist in Clinical Chemistry and Laboratory Medicine (EurClinChem)
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
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Title
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Academic
titles only, e.g.:
"Prof. Dr.", "Dr.", "Dr. rer. nat."
(not "Pharmacien", "Biologiste",..)
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First
Name
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"David", "Sarah"
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Middle Initials
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"M.", "William"
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Family
Name
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"Smith"
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Institution, Company
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"Hospital
de Santo António"
"Université de Paris"
"Laboratoire Medicale B&P"
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Department
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"Central
Laboratory"
"Institut für Klinische Chemie"
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Sex
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male female
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(please
select)
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Date
of birth
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(please
select)
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Street
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"1,
Avenue Charles de Gaulle"
"Königsberger Str. 34"
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Postcode
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without
country letter (NL, F)
"75016", "NR18
0PD"
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City
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"Paris", "Wymondham", "Hannover"
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Nationality
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(please
select)
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*
Country
of Residence
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(please
select)
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Telephone Country code
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"+49";
"+33"
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Telephone
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Including
area code (without zero)
"441-358674", "9-32-1920-89"
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Fax
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Including
area code (without zero)
"441-358674"; "4432-1920-89"
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E-Mail
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"david.williams@clinical-lab.com"
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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 Clinical Chemistry and Laboratory Medicine. In making this
application I affirm
that:
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I have read and understood the 'Guide
to the EC4 Register'
and the
accompanying syllabus
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I consider my training to meet the minimum standards in the 'Guide
to the EC4 Register'.
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I consider that I am competent to practise as specified in the 'Guide
to the EC4 Register'
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I shall abide by the EC4
Code of Conduct."
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.
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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
Association for Clinical Biochemistry to: The Association
for Clinical Biochemistry, 130-132 Tooley Street, London
SE1 2TU]
Credit card payment can not be accepted.
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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!
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