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:
- Name of Organization ……………………………………………………………………………
- Department (if applicable)
…………………………………………………………………………… - Type of Organization (Industry, Research or Universities, Other)
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- Country
…………………………………………………………………………… - Full Office address (Street, Nr, Post Code, City, Country)
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…………………………………………………………………………… - Office Phone
…………………………………………………………………………… - Office Fax
…………………………………………………………………………… - Website
…………………………………………………………………………… - Name of Contact Person
…………………………………………………………………………… - Phone
…………………………………………………………………………… - Email Address
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Applicant’s details (to be completed only if private person applies for membership):
- Name, Surname ……………………………………………………………………………
- Date and place of birth ……………………………………………………………………………
- Gender
…………………………………………………………………………… - Nationality
…………………………………………………………………………… - Country of Residence
…………………………………………………………………………… - Address/City/Town/Postcode
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…………………………………………………………………………… - Mobile phone
…………………………………………………………………………… - Contact email
…………………………………………………………………………… - Scientific degree
…………………………………………………………………………… - Education, occupation, position
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…………………………………………………………………………… - Scientific area
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…………………………………………………………………………… - Interest in Hydrogen safety activity
……………………………………………………………………………
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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.