| Please complete this application IN FULL,
in English, French or Spanish. |
| Formal or legal name of applicant
organization |
|
| Address |
|
| P.O. Box |
|
| ZIP/City |
|
| Country |
|
| Telephone |
|
| Fax |
|
| E-mail |
|
| Website |
|
| Name and title of the official to whom communications
should be addressed |
|
| Language preference for communications |
English
French
Spanish |
| Please submit 2 copies of the Governing
documents of your organisation. eg Charter, Articles and
Bylaws. One copy of all documents should be in one of the
official languages used by WMA, if possible. |
| If you have been unable to provide
a copy of your Charter or Articles in English, French or
Spanish, please describe briefly the purpose and the major
activities of your organization. |
|
| Is your organization an agency of government or financially
subsidized by government? |
Yes
No |
| If so, please explain |
|
| Is membership in your organization available to all physicians
licensed to practice medicine in your country? |
Yes
No |
| If not, please explain any restrictions
on membership |
|
| What are the geographic boundaries for your organization?
|
|
| Does the organization have members
in all geographic regions of the country? |
Yes
No |
| If not, please explain |
|
| Is membership in your organization
available to persons who are not physicians? |
Yes
No |
| If so, please identify the qualifications for such members
|
|
| Please estimate the total number
of physicians in your country |
|
| Please estimate the total number of physicians who are
members of your organization |
|
| Please estimate the total number
of members (ie. physicians and non-physicians of your organization)
|
|
| The subscription payable to the WMA
by a constituent member is assessed at a rate defined according
to the Gross National Income of the home country of that
member association. The dues rates are shared out in 4 categories
and are of 2,00; 1,50; 0,90 and 0,40 Euros. (Please see
the
document FPL/DuesCategories 2008/Oct2007 for reference).
The association in question is free to declare
the number of members for which it will be assessed for
the annual subscription, and this may be different to
the total membership of that association.
|
| If you are admitted to membership,
how many members do you intend to declare for the purpose
of assessment of your annual subscription? |
|
|
(Note: a constituent member has the right to appoint
one delegate to the Assembly for each 10,000 members it
has declared, or for any fraction thereof. It also has
one vote at the Assembly for each 10,000 members it has
declared, or fraction thereof. Any constituent member
of the WMA with more than 50,000 declared members in the
national association may appoint one member to the Council
for every 50,000 members declared.)
|
| Do you have a representative assembly
or general meeting of your members? |
Yes
No |
| How often do you have such meetings? |
|
| Do all of your members have the opportunity
to attend or to be represented at such meetings? |
Yes
No |
| If it is a representative assembly, please describe briefly
how the members are represented (eg. by delegates elected
from geographic or speciality constituencies, etc.) |
|
| Do members in attendance at such
meetings have the right to vote? |
Yes
No |
| Are some of the members, who have the right to vote at
such meetings, non-physicians? |
Yes
No |
| If so, please explain |
|
|
The annual subscription payable to the WMA is due
in January.
|
| Are there any currency regulations or restrictions in
your country that would prevent your organization from remitting
its annual dues to the WMA Secretariat in Ferney-Voltaire,
France? |
Yes
No |
| If so, please explain fully |
|
| Are there other medical or health organizations in your
country representing physicians? |
Yes
No |
| If so, please identify them and describe
their purpose briefly |
|
|
|
