Become a MPE member - Myeloma Patients Europe

This form collects the data shown below so we can process your MPE membership request. Check out our privacy policy to see how we protect and manage your submitted data. I have read and I accept the privacy policy

If you are interested in becoming a member of Myeloma Patients Europe, please fill in the form below

Organisation details

Organisation name*

Organisation acronym

Name of President/Chief Executive/Chair*

Is your organisation...

A foundation
An institute/clinic/hospital/research facility
Registered as non-profit

Date registered*

Address*

Street Address City ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Website

Phone

Organisation profile

Does your organisation deal with*

Myeloma only
General hematology
All blood cancer

How many people/members are registered with your organisation in total?*

How many myeloma patients/caregivers are registered with your organisation in total?*

Organisation activities

Which of the following do you provide

Information
Helpline
Support groups
Website
Patient/family days
Advocacy
Research

Any additional details on your organisational aims and activities

What type of membership are you applying for?*

Full member (patient group or patient association from a European country or region)
Associate member (non-European organisations, individual patients or healthcare professionals as well as corporations willing to make donations or to help in other ways)
Supporting members: Supporting members are individuals, foundations or corporations who have chosen to support the activities of the organisation through financial contributions or in-kind services. The type and amount of donation will be determined by the Board.

In order to proceed with your application, you should agree with the MPE contitution.*

Yes, I agree with the MPE constitution

_{Download the MPE Constitution in English (PDF version)}

Untitled*

I have read and I accept the privacy policy

CAPTCHA