MEDICHEM
Occupational and
Environmental Health
in the Production
and Use of Chemicals
Application for MEDICHEM Membership
Title
Gender
Date of Birth (optional)
First Name
Prefix (e. g. van, von, de)
Family Name
Company/Organization/Institute
Function/Position
Address (Street, Street Number
and any additional information)
Postal/Zip Code
City
Province/State
Country
E-mail-address
E-mail-address (please repeat)
Contact Phone Number
(including international code)
Mobile Phone Number
(optional)
(including international code)
Fax Number
Please indicate whether you
are a Member of ICOH
(International Commission on
Occupational Health)
Please indicate how you would
like to pay your Membership
Fee:
You can pay either by credit
card, PayPal, bank draft, or
international money order
under the following link:
Prof.
Male
Year:
Dr.
Drs.
Month:
Country Code
+
Country Code
+
City Code
Country Code
+
Yes
City Code
Annual Payment
of 40 €
Priv. Doz.
Female
Day:
Phone Number
Phone Number
Fax Number
No
Payment for 3
consecutive years in
advance at a
discount of 20 €
resulting in a rate of
100 € for the 3 years
http://medichem.org/membership.
asp#paymentlinks.
I herewith apply to become a
Member of MEDICHEM and
undertake to pay the
Membership Fee
Dr.h.c.
Please type your Name as
confirmation of your willingness:
Date:
My Company/
Organization/
Institute is a
Sustaining
Member of
MEDICHEM and
I need not to pay
individually
Please indicate your main fields of expertise or interest below. These will appear in the
address list and enable members with similar interests to contact one another:
Allergy and
Immunotoxicology
Health Promotion, Preventive
and Social Medicine
(Indicators of Job Strain,
Mobbing, Burn-Out,
Psychosical Factors, Work
Organisation, Addictions,
Substance Abuse Policies,
Wellbeing, Fitness for Work
Issues, Work and Vision)
Prevention of Work-Related
Injuries and Diseases
Aging and Work
Health Services Research
and Evaluation in OH
Radiation and Work
Asthma and Respiratory
Diseases
Health Surveillance,
Analytical Methods,
Imaging in OM
Regulatory Toxicology,
Occupational Exposure
Limits, Occupational
Diseases, REACH, GHS/CLP
Biological Hazards and
Microbial Toxicity
Hearing Conservation,
Occupational Hearing Loss
Reproductive Hazards in the
Workplace (Teratology,
Developmental Toxicity)
Biomonitoring,
Biomarkers,
Metabolism
History of Prevention of
Occupational and
Environmental Diseases
Shiftwork and Working Time
Chemical Carcinogenesis,
Occupational Cancer
Indoor Air Quality and Health
Small-Scale Enterprises and
the Informal Sector
Education and Training in OH
Injury and Disability
Management,
Accident Prevention,
Medical Rehabilitation and
Compensation of
Occupational Accidents and
Diseases,
Rehabilitation Facilities,
Social Medicine,
Integration,
Inclusion
Special Industries
Chemical, Pharmaceutical
Colour, Paint
Enzyme, Food
Fertilizers, Pesticides
Flavours, Fragrances
Laundry, Cleaning, Solvents
Organophosphates
Petrochemical, Refineries, Oil
Rubber, Plastics
Emergency Response,
Acute Clinical Toxicology,
Accident Hospitals,
Office of Emergency
Management (OEM),
Advanced Hazmat Life
Support
Nanomaterial Toxicity and
Workers’ Health
Special Substances
Asbestos, Fibres, CNT
Chlorine, Chlorinated
Solvents
Detergents
Endocrine Disruptors,
Hormones
Formaldehyde
Hydrocarbons
Hydrofluoric Acid (HF)
Phthalates
Vinyl Chloride
Metals
Environmental Health
Neurotoxicology and
Psychophysiology
Risk Analysis,
Risk Assessment,
Risk Management,
Responsible Care,
Product Safety
Ergonomics,
Work at VDU's (visual display
unit),
Musculoskeletal Disorders
Occupational and
Environmental Dermatoses
Toxicology,
Toxicological Evaluation
Exposure Assessment,
Exposure Modelling
OH for Health Care Workers
and Medical Doctors
Travel Medicine
Genotoxicity and Epigenetics
OH in the Chemical Industry
Unemployment,
Job Insecurity and Health
Global Medicine,
Globalisation of Standards,
Governance,
International Health Threat
Analysis,
International OEM (Office of
Emergency Management),
One Health
Occupational Health Nursing
Vibration and Noise,
Thermal Factors,
Electromagnetic Fields
Health and Environment
Policies,
Health Management
Systems,
Policy and Litigation Support
Occupational Medicine
Women Health and Work,
Gender Specific Questions
After you completed this form, please save it in your files, and return the form as an
attachment (as word document) by e-mail to:
maren.beth-huebner@bgrci.de
Dr. Maren Beth-Hübner
Secretary of MEDICHEM
BG RCI (German Social Accident Insurance Institution for the Raw Materials and Chemical
Industry)
Kurfürsten-Anlage 62
69115 Heidelberg (GERMANY)
Tel.: +49 6221 5108 28451
Fax: +49 6221 5108 21199
e-mail: maren.beth-huebner@bgrci.de