Membership-application Medical-Journalist

Fill in the application form, upload your passport photo and you will soon receive your press card!

If you have difficulties using the online application form, you can send your membership application by post. Download our PDF form for this purpose: Download

All personal data is confidential and will not be passed to third parties; it will only be used for purposes related to your membership.

Personal data
Company:
Last name: *
First name: *
Street / Nr: *
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Birthday: *
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Zip: *
City: *
Country: *
Email: *
Phone: *
Mobile:
Passport-Image
Please upload your passport-image here.

Fileformats: .gif / .jpg / .jpeg / .png
Filesize: max. 5 MB

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Payment

Invoice (press card will be sent on receipt of payment and verification of the data.)

per Paypal (press card will be sent on receipt of payment and verification of the data.)

Direct debit (Please enter your account details in the fields provided!)

I hereby authorise the Deutsche Foto-Journalisten e.V. to debit the annual membership fee automatically from my account as well as the one-off cost of the press card.

Account holder: *
BIC: *
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IBAN: *
I became aware of the DFJ through...



Specifications
I am applying for membership of Medical-Journalist (Dr. Schellerer Straße 59, 94234 Viechtach, Germany).

The annual membership fee is EUR 83.00 (EUR 41.50 for the half-year from June 2015). I can terminate the membership before the end of each year by 31 October at the latest.

In the subsequent years I will automatically receive the press cards as part of my membership for an annual fee of EUR 83.00. Medical-Journalist reserves the right to reject applications or to request evidence of employment.
I confirm that I work full time or mostly full time in the medicine sector and I am enclosing editorial confirmation or proof of employment.
I substantiate the validity of my given data.

* mandatory fields

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