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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: Prof. Abraham Zlotogorski Department of Dermatology -Hadassah Hebrew University Medical Center P.O.B. 12000 Jerusalem 91120, Israel Email: secretariat@ehrs.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 ................................... Date of birth: ..................................... Nationality: ........................................ Membership to other scientific societies: ................................................. ............................................................................................................... ............................................................................................................... I have included one letter of recommendation from a current, active EHRS member Signature: ............................................................................................ Date: ................................................................................................... | ||||||