Application to IHE Europe

A. Organisation Information

Legal entity name*

Address*

City*

Postal code*

Country*

Website

B. Membership category and fee

At the date of signature, our organisation falls into the following category - please tick your choice

National Deployment Initiative - € 4000 (incl. IHE International fee)

Vendor Associations - €4100

Large Vendors (>2500 FTE) - €4100

Mid-Sized Vendor (250-2500 FTE) - € 2100

Small Vendors (< 250 FTE) - €1000

User Organisation - € 600

Competence Center - € 600

Government Agency - € 2100

Benefactor - € 0

* Note that 21% VAT will be added to the fees where applicable.

C. Representative contact information

We nominate the following person as the general representative of our organisation towards IHE-Europe:

Name*

Title*

Address*

Postal code*

City*

Country*

E-mail address*

Re-enter e-mail address*

Phone number*

Mobile Number

Fax

For National Initiatives

We nominate the following persons as the general representatives of our organisation towards IHE-Europe

User Co-Chair

Name

Title

E-mail address

Phone number

Mobile Number

Fax

Vendor Co-Chair

Name

Title

E-mail address

Phone number

Mobile Number

Fax

D. IHE-Europe Committees

We are interested in nominating a representative for the following Committees:

EU Affairs Committee

MarCom Committee

IHE-Services Committee

*Note: To join IHE-Services, you have to file a separate application. For further information, please contact secretariat@ihe-services.net

Policies of IHE-Europe

I hereby acknowledge that I have read, understood and agree to the Statutes of IHE-Europe as amended and to any other rules and regulations established by the IHE-Europe General Assembly. I also understand and accept that those documents may be updated or revised where appropriate.

I agree to the Policies of IHE-Europe.*

Intellectual Property Agreement

We have already signed the Intellectual Property Agreement of IHE International. Our organisation is an accepted member of IHE International and/or has been accepted as an IHE National Initiative by IHE International.

I agree to the Intellectual Property Agreement*

Add your comments