Application Form for YARE Membership
Personal Details
Title:
First Name*:
Last Name*:
Telephone:
Email*:
Date of Birth*:
Affiliation
Institute*:
City*:
Country*:
Supervisor/Head of
group*:
Email supervisor:
* required fields
YARE membership is free of charge. Please note that all personal data are collected for statistical and
organizational reasons only. Personal data will be treated as confidential and will not be passed on to
third parties. You hereby agree on receiving information about YARE via email. This agreement
can be revoked at any time. If you have any questions, do not hesitate to contact yare@yareendo.de.
Date
Signature
Additional information
In order to improve our program and events and for statistical reasons, we would like to ask you some
additional questions about your scientific background, your research interests etc. Please double-klick
on the fields, to activate them.
1. Sex
Female
Male
Other
2. How old are you?
<20 years
20-25 years
25-30 years
>30 years
3. Where do you come from (nationality)?
Germany
Other, please specify (not mandatory): _____________________________________
4. In which country do you work?
Germany
Other, please specify (not mandatory): _____________________________________
5. What is your track of professional education?
Natural science (biology, chemistry, pharmacy, physics, earth/space sciences…)
Please specify: ______________________________________
Medicine
Humanities
Social Sciences
6. What is your current position?
Student
PhD student
PhD postdoc
MD (medical doctor, physician)
Other, please specify: ______________________________________
7. Where do you work?
Industry
Academic institution (i.e. university, university hospital)
Non-academic hospital
Scientific institution (i.e. foundation)
Other, please specify: ______________________________________
8. What is your general research area?
Basic
Clinical
Translational
9. What is your field of research?
Adrenal
Bone
Diabetes and Obesity
Endocrine Malignancies
Growth Hormone
Metabolism
Pituitary
Reproduction
Thyroid
Other, please specify: ______________________________________
10. How did you hear about the YARE?
German Endocrine Society (DGE) website
German Endocrine Society Conference
European Society of Endocrinology Conference
Bregenz Summer School
Facebook
Flyer
Friends/ Colleagues
Supervisor
YARE website
Other, please specify: ______________________________________
11. How many annual YARE meetings have you already attended?
0
1
2
3
4
5
>5
Please send the filled document (as Word file) to yare@yare-endo.de.
In addition, please send a signed version as PDF-file/picture to yare@yare-endo.de. The signed version
can also be sent to:
Alexander Fischer
Universitätsklinikum Hamburg-Eppendorf
Institut fuer Biochemie und Molekulare Zellbiologie (N30); 3. Stock
Martinistrasse 52
20246 Hamburg, Germany