EUROPEAN HAIR RESEARCH SOCIETY (EHRS) APPLICATION FORM

Click here for a Microsoft Word format application form

Send the completed form along with one letter of recommendation from a current, active EHRS member to:

Dr. Gill Westgate, MD
EHRS Secretary
40 Court Lane
Stevington
Bedford
MK43 7QT
United Kingdom

Email: secretariat  (at)  ehrs   (dot)  org

I wish to apply for active membership of the EHRS society

Surname: ...........................................................................

First name: ........................................................................

Company/institution: .........................................................

Street, no.: .........................................................................

Town/city: ...........................................................................

post code: ..........................................................................

Country: ..............................................................................

Title (Prof., Dr., Mr., Miss., Mrs.) ......................................

l can be contacted at my business office:

Phone: ................................................................................

Fax: .....................................................................................

Email: ..................................................................................

Best day in the week:   M   T   W   T   F   S   (circle)

Best time in the day:                am / pm

l can be contacted at home:

Phone: ................................................................................

Fax: .....................................................................................

Email: ..................................................................................

Best day in the week:   M   T   W   T   F   S   (circle)

Best time in the day:               am / pm

Main activities in hair research (tick those that apply)

biology in vivo ...................................
biology in vitro ..................................
biophysics .........................................
biochemistry .....................................
clinic ..................................................
endocrinology ...................................
experimental pathology ...................
genetics ............................................
histopathology ..................................
immunology ......................................
evaluation .........................................
other fields ........................................

Date of birth: .....................................

Nationality: ........................................

Membership to other scientific societies: .................................................

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I have included one letter of recommendation from a current, active EHRS member

Signature: ............................................................................................

Date: ...................................................................................................