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, 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 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 ENUSP, Zabel-Krueger-Damm 183, 13469 Berlin, Germany.

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 ABN AMRO in Utrecht, Netherlands, Account: 534557082, Sort Code: ABN-NL 2A
Account holder: Vereniging European Network
Transnational payments: International Bank Account Number (IBAN Code): NL54ABNA0534557082, Bank Identifier Code (BIC / Swift Code): ABNANL2A
Bank's postal address: ABN AMRO, Neude, Postbus 30, 3500 AA Utrecht, The Netherlands
We prefer paying our membership fee with credit card through PayPal to desk@enusp.org  Pay us securely with any major credit card through PayPal!   Visa MasterCard American Express Switch Debit Cards Solo Debit Cards Visa Delta Visa Electron 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
Peter Lehmann, Secretary of the ENUSP Board