European Network of (ex-) Users and Survivors of Psychiatry

If you have installed a web-based service as pre-adjusted e-mail-application (for example Yahoo-mail or Hotmail), then our form will probably not work. In this case we kindly ask you to print the form and send it by letter (address: European Network of (ex-)Users and Survivors of Psychiatry, LAP, Vesterbrogade 103, 1.sal , 1620 Copenhagen V, Denmark , Phone: 0045 33261623,) or send the message as normal e-mail-text to enusp.info@gmail.com

	We want to become member of ENUSP
	We want to be listed on the ENUSP Group Registry [www.enusp.org/groups.htm]

If you want to become a ENUSP Support Member, please click here

Organisation's name
Organisation's name in English translation
c/o		Building
Street & house no.		Country
Zip code		City
State		Phone
Fax		E-mail
Additional remark

1) Organisation form (national/central, regional, local)

2) We are a democratic organisation.

3) Level of involvement of users / ex-users / patients / clients / consumers / mentally ill persons / survivors of psychiatry in decision making procedures

4) If national organisation: Number, place and date of legal registration

5) Statutes of our organisation

We read the ENUSP statutes and know, that the ENUSP needs our statutes for approving our membership-application. We know, that a translation of the statutes is not needed. We have sent a copy of our statutes by separated mail to European Network of (ex-)Users and Survivors of Psychiatry, LAP, Vesterbrogade 103, 1.sal , 1620 Copenhagen V, Denmark , Phone: 0045 33261623,.

6) Membership fee

We know, that at the ENUSP General Assembly on July 20, 2004, a membership fee was decided, based on € 0.10 per individual member of each member organisation, that the fee should be paid annually, and that exceptions for members that do not have enough money to pay are possible and can be agreed by the ENUSP board.

7) Number of members

8) We want to have a reduced membership fee, because ...

9) If our membership application will be accepted, we will pay for this year

Example: If your organisation has 250 individuals as members, please pay 250 x € 0.1 = € 25.– each year [Currency calculator]

10) Payment form

We will transfer the money to Danske Bank, Holmens Kanal 2-12, 1092 Copenhagen K, Denmark ,
Account holder: ENUSP - European Network of (Ex-) Users and Survivors of Psychiatry,
International Bank Account Number (IBAN Code): DK7630003719376320, Bank Identifier Code (BIC / Swift Code): DABADKKK

We prefer paying our membership fee with credit card through PayPal to desk@enusp.org American Express Switch Debit Cards Solo Debit Cards eCheck

If you would like more information about PayPal before placing your transfer, visit them at www.paypal.com

11) Name and position of the person applying for membership

Data for ENUSP Group Registry [www.enusp.org/groups.htm]
12) Target group of our organisation

13) Our aims

14) Status of workers (paid/volunteers, paid users/ex-users/patients/clients/consumers/mentally ill persons/survivors of psychiatry?

15) Funding (subsidized by the government / own funding / pharmaceutical industry / Other: namely

16) Is there a decision to taky money from the pharmaceutical industry if it is offered?

17) Web site, publications

In the name of ENUSP board,
kind regards
Gabriela Tanasan, Chair of the ENUSP Board