IUR - Membership application form

UNION INTERNATIONALE DE RADIOECOLOGIE
INTERNATIONAL UNION OF RADIOECOLOGY

UIR/IUR MEMBERSHIP APPLICATION FORM
ALL FIELDS ARE COMPULSORY, EXCEPT WHEN INDICATED

Last Name :		Date of birth (day/month/year) :
First name(s) :

Office Address (full address) :

City :	Zip code :
Country :	Email :	Will be used to send your confirmation
Phone :	Fax :

Home Address (full address) :

City :		Zip code :
Country :		Email (optional) :
Phone (optional) :		Fax (optional) :

Current academic and/or professional position :

Education (if you are a student, please indicated the diploma(s) you are preparing)
Diploma(s)	University(ies)	Year(s)

Professional experience (please provide a short description of your professional experience)

Curriculum Vitae and Publications (please annex to this application form a CV and a list of relevant publications (RTF or PDF formats are accepted)
CV :
Publications :

Recommendations (Name and email addresses of two Regular Members)
1. Name		Email :
2. Name		Email :

Mailing (Check appropriate answer) I authorize UIR/IUR to provide my mailing address to private companies and institutions for advertisements in the field of radioecology and radiation protection
YES	NO

Submit your application form

You can also print and send your application by mailing this application form to the IUR Membership Secretariat at: Mrs Lydie Emonides
IRSN, DESTQ/DIR Centre d’Études de Cadarache,
Bât 229, BP 3,
13115 Saint-Paul-lez-Durance, France
Tel : +33 (0)4 42 19 97 35
Fax : +33 (0)4 42 19 91 54
Mailbox : webmaster@iur.uir.org