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: ENUSP Secretariat, Zabel-Krueger-Damm 183, D-13469 Berlin) or send the message as normal e-mail-text to desk@enusp.org
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 Data

Organisation's Name
Organisation's Name in English translation
c/o
Building
Street, house no.
Country
Zip code
City
State
Phone
Fax
eMail
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 have sent a copy of our statutes by separated mail to ENUSP Secretariat, Zabel-Krueger-Damm 183, D-13469 Berlin.

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 the first year

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

10) Membership fee transfer
We will transfer the money to the bank account of ENUSP: ABN AMRO in Utrecht, The Netherlands, Account: 53.45.57.082 SWIFT: ABN-NL 2A / International Bank Account Number (IBAN): NL54 ABNA 0534 5570 82. Bank Identifier Code (BIC): ABNANL2A
We will send a cheque to ENUSP Desk, Zabel-Krueger-Damm 183, D-13469 Berlin
We prefer paying our membership fee with credit card through PayPal! If you would like more information about this company before placing your transfer, visit them at www.paypal.com  Pay me securely with any major credit card through PayPal!   Visa MasterCard American Express Switch Debit Cards Solo Debit Cards Visa Delta Visa Electron eCheck

11) Name and position of the person applying for membership




Data for publication in the 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

After receipt of your mail, the ENUSP Secretary will promptly send a confirmation.

Kind regards
Peter Lehmann, Interim-Secretary of ENUSP