JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
DGUHT e.V. - Declaration of accession
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First name, last name, title if applicable
*
Your answer
Company (optional)
Your answer
Address (street, postcode, city)
*
Your answer
Telephone number
Your answer
Yes, I/we support the activities of the DGUHT e.V. and hereby apply for membership as a
*
The reduced rate applies to pupils, students, unemployed, pensioners.
Regular member at a single fee of 75 euros per year (standard)
Regular member at the reduced rate of 35 euros per year (proof required)
Supporting member (amount freely selectable). No voting rights at the general meeting.
Required
Additions - e.g. joining the Clinical Toxicology Working Group. In this case, the annual fee for 2021 is waived
Your answer
Only in the case of the selection "Supporting member" enter the amount here (e.g. 100€).
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
