New member application « Hellenic Association of Endodontists

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To the Board of Directors

I hereby apply for membership in the Hellenic Association of Endodontists. I declare that I agree with the mission of the Hellenic Association of Endodontists as stated in the article 2 of the Memorandum and that I fulfill all the requirements stated in the article 7 of the Memorandum.
Please accept my application.

If accepted into membership by the Committee of Directors, the hereby applicant is due to pay the subscription fee to the Association.

The subscription fee for the year 2014 is 100,00 €.

For the subscription payment, please use the Association’s Bank Account:

Piraeus Bank
Acc. No 5050-063397-887
IBAN GR58 0172 0500 0050 5006 3397 887
Please send the deposit receipt via email:  info@greekendodontists.gr

Last Name:
First Name:
Son of:
Office Address:
Telephone:		Mobile Phone:
email:
website:
Dental School:

Year of Graduation:
Advanced Specialty Education Program in Endodontics:

Duration of Program:		Year of Graduation:
Academic Degrees: