Apply for membership

Membership Application Form for the International Association for Hydrogen Safety – IA HySafe

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Please print this page (or the pdf file), fill it out and send it per email to the association secretary:

Frank Markert (fram@dtu.dk)
Department of Management Engineeering
Safety & Risk Management Group
Technical University of Denmark
Produktionstorvet 424
DK-2800 Kongens Lyngby

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Organization details:

  1. Name of Organization ……………………………………………………………………………
  2. Department (if applicable)
    ……………………………………………………………………………
  3. Type of Organization (Industry, Research or Universities, Other)
    ……………………………………………………………………………
  4. Country
    ……………………………………………………………………………
  5. Full Office address (Street, Nr, Post Code, City, Country)
    ……………………………………………………………………………
    ……………………………………………………………………………
    ……………………………………………………………………………
    ……………………………………………………………………………
  6. Office Phone
    ……………………………………………………………………………
  7. Office Fax
    ……………………………………………………………………………
  8. Website
    ……………………………………………………………………………
  9. Name of Contact Person
    ……………………………………………………………………………
  10. Phone
    ……………………………………………………………………………
  11. Email Address
    ……………………………………………………………………………

Applicant’s  details (to be completed only if private person applies for membership):

  1. Name, Surname ……………………………………………………………………………
  2. Date and place of birth ……………………………………………………………………………
  3. Gender
    ……………………………………………………………………………
  4. Nationality
    ……………………………………………………………………………
  5. Country of Residence
    ……………………………………………………………………………
  6. Address/City/Town/Postcode
    ……………………………………………………………………………
    ……………………………………………………………………………
    ……………………………………………………………………………
    ……………………………………………………………………………
  7. Mobile phone
    ……………………………………………………………………………
  8. Contact email
    ……………………………………………………………………………
  9. Scientific degree
    ……………………………………………………………………………
  10. Education, occupation, position
    ……………………………………………………………………………
    ……………………………………………………………………………
  11. Scientific area
    ……………………………………………………………………………
    ……………………………………………………………………………
  12. Interest in Hydrogen safety activity
    ……………………………………………………………………………
    ……………………………………………………………………………

Membership is open to legal entities and private persons interested in hydrogen safety.

Yearly Membership fees:

For large and medium industry and research institution, associations: 2500 €

For small industry and research institution, Universities: 750 €

Private person (as associated member only):  100 €

I, herby, accept the conditions for membership as laid down in the statutes and apply the admission to IA HySafe as full / associated / private member

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Signature of applicant

 

The association reserves the right to refuse membership applications.
The applicants will be informed accordingly.

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