Aplication for membership in ITMA

International Traffic Medicine association

 

Click on relevant "radio buttons", make necessary comments and submit your application to ITMA treasurer, by clicking "Submit" button at the bottom of the page!

Choose actual date etc:
Application date:       



 Application for:   Individual
  NGO
  GO

* indicates obligatory information
* Last Name (family name): (e.g. Smith)
* First (given) name and other initials: (e.g. James B.)
Title:
Discipline:
Degrees: (e.g. BA)
Organization: (e.g. Ministry of Transport)
Your position: (e.g. Director General)
* Address (street, number, or PO-box):
ZIP / Postal code: 
* City: 
State / Province:
* Country:
Telephone (incl. country and area code):
Fax:
* email address:
* repeat email address:

* Membership fee:

  Full (US $ 85)
 Reduced 1 (US $ 45)
 Reduced 2 (US $ 15) 		 ITMA dues is currently set to US $ 85 to present as low a barrier as we could to encourage partcipation by the widest possible range of occupations from all nations.
Extra contribution for ITMA: US $ Extra contribution is of great value for our work!

* Preferred payment mode:

  Credit card
 Check		 Instructions for payment will be sent to you by email.
Submitted details will be stored in a database and treated according to Swedish and EU laws. 

Thank you for joining ITMA!

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