Application form

Name:

Surname:

Personal identification number (OIB in Croatia):

Date of birth:

E-mail:

Alternative e-mail:

Institution of employment:

Institution's address:

Institution's city:

Institution's state:

Home adress:

Home city:

Home state:

University finished (name, city, state):

I confirm that I am aware of and accept the rights and obligations related to membership, and determined by the By-Laws of HDBMB
I confirm that my personal data can be used for the purpose of HDBMB activities.
I want to receive information from HDBMB.