Application for MEDICHEM Membership

Application for MEDICHEM Membership

Title / Prof. / Dr. / Drs. / Priv. Doz. / Dr.h.c.
Gender / Male / Female
Date of Birth (optional) / Year: / Month: / Day:
First Name
Prefix (e. g. van, von, de)
Family Name
Company/Organization/Institute
Function/Position
Address (Street, Street Number and any additional information)
Postal/Zip Code
City
Province/State
Country
E-mail-address
E-mail-address (please repeat)
Contact Phone Number
(including international code) / Country Code
+ / City Code / Phone Number
Mobile Phone Number (optional)
(including international code) / Country Code
+ / Phone Number
Fax Number / Country Code
+ / City Code / Fax Number
Please indicate whether you are a Member of ICOH (International Commission on Occupational Health) / Yes / No
Please indicate how you would like to pay your Membership Fee:
You can pay either by credit card, PayPal, bank draft, or international money order under the following link: / Annual Payment
of 40 € / Payment for 3 consecutive years in advance at a discount of 20 € resulting in a rate of 100 € for the 3 years / My Company/ Organization/ Institute is a Sustaining Member of MEDICHEM and I need not to pay individually
I herewith applytobecome a Member ofMEDICHEM and undertake to pay the Membership Fee / Please type your Name as confirmation of your willingness: / Date:

Please indicate your main fields of expertise or interest below. These will appear in the List of MEDICHEM Members Worldwide with Expertise Databank and enable Members with similar interests to contact one another:

Allergy and Immunotoxicology / Health Promotion, Preventive
and Social Medicine (Indicators of Job Strain, Mobbing, Burn-Out,
Psychosical Factors, Work Organisation, Addictions, Substance Abuse Policies, Wellbeing,Fitness for Work Issues, Work and Vision) / Prevention of Work-Related Injuries and Diseases
Aging and Work / Health Services Research and Evaluation in OH / Radiation and Work
Asthma and Respiratory Diseases / Health Surveillance, Analytical Methods,
Imaging in OM / Regulatory Toxicology, Occupational Exposure Limits, Occupational Diseases, REACH, GHS/CLP
Biological Hazards and
Microbial Toxicity / Hearing Conservation,
Occupational Hearing Loss / Reproductive Hazards in the Workplace (Teratology, Developmental Toxicity)
Biomonitoring,
Biomarkers,
Metabolism / History of Prevention of Occupational and Environmental Diseases / Shiftwork and Working Time
Chemical Carcinogenesis,
Occupational Cancer / Indoor Air Quality and Health / Small-Scale Enterprises and the Informal Sector
Education and Training in OH / Injury and Disability Management,
Accident Prevention,
Medical Rehabilitation and Compensation of Occupational Accidents and Diseases,
Rehabilitation Facilities, Social Medicine,
Integration,
Inclusion / Special Industries
Chemical, Pharmaceutical
Colour, Paint
Enzyme, Food
Fertilizers, Pesticides
Flavours, Fragrances
Laundry, Cleaning, Solvents
Organophosphates
Petrochemical, Refineries, Oil
Rubber, Plastics
Emergency Response,
Acute Clinical Toxicology, Accident Hospitals,
Office of Emergency Management (OEM),
Advanced Hazmat Life Support / Nanomaterial Toxicity and Workers’ Health / Special Substances
Asbestos, Fibres, CNT
Chlorine, Chlorinated Solvents
Detergents
Endocrine Disruptors, Hormones
Formaldehyde
Hydrocarbons
Hydrofluoric Acid (HF)
Phthalates
Vinyl Chloride
Metals
Environmental Health / Neurotoxicology and Psychophysiology / Risk Analysis,
Risk Assessment,
Risk Management, Responsible Care,
Product Safety
Ergonomics,
Work at VDU's (visual display unit),
Musculoskeletal Disorders / Occupational and Environmental Dermatoses / Toxicology,
Toxicological Evaluation
Exposure Assessment,
Exposure Modelling / OH for Health Care Workers and Medical Doctors / Travel Medicine
Genotoxicity and Epigenetics / OH in the Chemical Industry / Unemployment,
Job Insecurity and Health
Global Medicine, Globalisation of Standards,
Governance,
International Health Threat Analysis,
International OEM (Office of Emergency Management),
One Health / Occupational Health Nursing / Vibration and Noise,
Thermal Factors, Electromagnetic Fields
Health and Environment Policies,
Health Management Systems,
Policy and Litigation Support / Occupational Medicine / Women Health and Work, Gender Specific Questions

After you completed this form, please save it in your files, and return the form as an attachment (as a Word document) by e-mail to:

Prof. Dr. Kenneth A. Mundt

Secretary General of MEDICHEM

+1 857 300 0288