IPCRG Invited Organisation Application Form

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Please answer the questions below to complete your application to become an IPCRG Invited Organisation

Please note you may include links to website addresses in response to the questions. If you would like to provide documents in response, please email these to BusinessManager@ipcrg.org including IPCRG Invited Organisation Application in the email header.

Country and main location *

Name of your group and contact information, such as address and telephone number. *

Tick here to sign
*

We hereby consent and agree to become a member of International Primary Care Respiratory Group (Scottish Company Number 256268) which is hereinafter referred to as "the Company".

We agree that if the Company is wound up whilst I/we am/are a member of the Company or within one year after I/we cease to be a member of the Company, then I/we will contribute such amount as may be required, not exceeding £1, in terms of Clause VI of the Company's Memorandum of Association towards the debts and liabilities of the Company and the costs, charges and expenses of winding up the Company.

Required

Postion (state position if signing for an organisation)
*

Special Interests
*

Please tick category of associate membership:
*

Individual

Not-for-profit organisation

For profit corporate body (if you tick this box an invoice will be sent out to you on receipt of this form by the Secretariat.)

For profit device company (if you tick this box an invoice will be sent out to you on receipt of this form by the Secretariat.)

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