Membership household

Anybody is free to become a member of the association. There is no qualifying period for new members.

The annual membership fee is 50€ for a household and is valid for the current fiscal year (1st January to the 31th December).

Members regularly receive informations about the activities of the Patiente Vertriedung asbl (publications, conferences, activity reports, newsletter, etc.).

Please fill out the form below if you want to become a member of the PATIENTE VERTRIEDUNG asbl.

Title

Name (Musterman)

First name (Max)

Social security number (1980 01 01 000 00)

Civil status

Nationality

Phone (+352 49 14 57 1)

E-Mail (info@patientevertriedung.lu)

First name of the partner (Max)

Last name of the partner (Mustermann)

Social security number (1980 01 01 000 00)

Nationality

Phone (+352 49 14 57 1)

E-Mail (info@patientevertriedung.lu)

Number of children

Name of the first child (Max Mustermann)