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European Society for Clinical Virology
Application for Membership
for subscription year 1 January to 31 December 2016
Membership of the Society is open to anyone interested in viruses as causes of disease in man and
animals, including general, pediatric or veterinary clinicians, infectious disease physicians, diagnostic
virologists or microbiologists, and pure or applied virologists. Members may attend scientific meetings of
the ESCV at special discounted registration fees. Members may also subscribe to the
Journal of Clinical
Virology
at a special discounted rate.
1. Personal details
Surname/Family name
Forenames
Title (Prof/Dr/Mr/Mrs/Miss/Ms)
Gender (
tick box
)
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Male
͘
Female
Date of birth
Institution
Work address
(givefull details including department within
Home address
institution/company)
Postal/Zip code
Country
Postal/Zip code
Country
Tel. no. (
incl.country code
)
Tel. no. (
incl.country code
)
Fax
Fax
Preferred address for receipt of correspondence/journals etc. (
tick box
)
͘
Work
͘
Home
2. Membership/
Journal of Clinical Virology
subscription
͘
I wish to become a member (
2015) subscription € 40
)
͘
I have been a member previously and I wish to rejoin (
2015) subscription € 40
)
͘
I wish to subscribe to
Journal of Clinical Virology
(
2015) subscription € 63)
3. Main areas of scientific interest in virology
List not more than 6.
4. Declaration
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