Membership
 

The ISHM membership form must be completed and sent to :

Prof. Dana BARAN
Department of Interdisciplinary Sciences
Faculty of Medicine, "Gr.T.Popa" University of Medicine and Pharmacy
Str. Universitatii, nr.16
700115 IAŞI, ROMANIA
dana_baran@yahoo.com

Membership form

Fill in the form, and then click on 'send'. If you do not have e-mail, print the form and send it by mail to the above address.

Titre
Surname
Forenames
Date of birth
Adress
Phone
Fax
E-mail
Languages spoken fluently
Languages read
Your experience in the History of Medicine
Historical fields of interest
Periods studied
Current research
Published works
Do you teach the history of medicine ?
Are you affiliated with another institution associated with the history of medicine (e.g., a museum, library) ?
If so, which one ?
Would you be available for translations for Vesalius or for the Internet site ?
If so, from which language to which language ?
Date