Application form to enter AEPROMO for physicians, dentists and veterinarians – Ordinary Members: With the right to speak and to vote

Please take into account the following:

(1) Fill in all the data in the following application form and click “Send”. After “sending” it pay the membership fee using the methods of payment that will appear once you have sent the request. AEPROMO will contact you once the Board of Directors has decided on your request.

(2) The following data from the application form will be publicly used to be posted on the AEPROMO website, “find a professional” tab: Names and surnames, professional address, city, province, community (Spain), postal code, country, professional telephone, profession, specialty. By submitting the application form dully filled out you are accepting that the indicated above-mentioned data is public.

(3) The other data will be for the exclusive use of AEPROMO.

 

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    Name (required)

    Surname (required)

    Professional address (required)

    City (required)

    Province (state, department) (required)

    Community (mandatory only for persons in Spain)

    Zip code (required)

    Country (required)

    Business Phone(s) (required)

    Personal Phone(s) (not required)

    Email (required)

    Profession (required)

    Speciality (If you have it) (required)

    Twitter (if available)

    Web (if available)

    Birth Date (required)

    NID (National Identity Document or similar) (required)

    The number of your Professional Identity Card (required)

    Name of the entity that issued your professional card (required)

    Only if you have a bank account in any country of the European Union

    Order payment by direct debit:

    Company bank account

    I accept Privacy Police de AEPROMO (obligatorio)

    I accept the sending of commercial communications

    To avoid spam, please answer this security question

    Persons not resident in Spain must submit the following scanned documents by email to ” info@cursotenenciaresponsable.com ”

    • NID (National Identity Document or similar)
    • Medical College of Physicians or Professional Identity Card

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    This content is also available in: Spanish

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