BWGCPE Effective Membership Form

BEHRA Effective member Membership Form

See also the "News from the Nucleus"

The prerequisite to be an effective member (formerly called board member) of the BEHRA is to accept an active participation in the activities of the Nucleus (formerly called the Board).

All associate members are eligible to be effective members as soon as membership dues have been paid.

Three conditions have to be met:

- the candidate has to submit an application form together with a curriculum vitae demonstrating the specific involvement in arrhythmology.

- the applicant should agree to take an active part in the management of arrhythmology problems in the Nucleus.

- the applicant should have presented at least one oral abstract or poster at one of the BEHRA sessions or at an international arrhythmology meeting, as the first author.

- the applicant has to be a member of the Belgian Society of Cardiology

The application will be examined by the Nucleus, only on the basis of the above stated criteria. There will be no vote, no sponsorship.

The number of effective members is illimited.

The effective member is expected to attend several annual meetings of the Nucleus and also to attend specific study groups (pacing, electrophysiology, ablation, clinical arrhyhmology) in which he will be actively involved.

The applicant should preferably have an Email adress.

If you wish to be an effective member of the Belgian Working Group on Cardiac Pacing and Electrophysiology, fill out the form below and send your curriculum vitae to either the flemish speaking or the french speaking secretary.

A acceptance letter will be send to the candidate after reception of the application form and verification that all conditions are met.

Please, do not use accentuated characters. Use only the mouse. Do not use "Enter" or "Return".

First name:

Last name:

Language:French Dutch

Birthdate (dd/mm/yyyy):

Private adress:

Professional adress:

Private phone:

Professional phone:

Fax:

Email:

GSM:

Professional occupation:

Arrhythmology occupation:

Abstract reference:

I agree to follow as close as possible the arrhythmology guidelines proposed by the BEHRA. I am willing to take an active part in the management of arrhythmology problems as organised by the Nucleus. I agree to attend at least 50 % of the meetings of the Nucleus (the Nucleus meets +/- 4 times/year) and also specific study groups (pacing, electrophysiology, ablation, clinical arrhythmology) in which I will be involved. I agree to participate to all present of future databases and to every peer review process organized by the BEHRA according to the modalities defined by the Board. I am a member of the Belgian Society of Cardiology in due form or intent to do so in the following weeks.

Enter the 5 numbers shown on the image here:

You will receive an acceptance message after a few seconds if the form is valid

A acceptance letter will be send to the candidate after reception of the application form + CV and verification that all conditions are met and presentation of the application form and the curriculum vitae to the Nucleus of the BEHRA.

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