ILAE - YES Registration Form - Newsletter
The Young Epilepsy Section (YES) of the ILAE is a world-wide organization of young people in the early stages of a career focused on the care of people with epilepsy, and/or epilepsy research.

Please note that all ILAE junior members (being < 40 years of age) are automatically part of YES. No further registration is needed.

Fill out this form in order to receive our newsletter and additional information about YES via email!

The information provided are for internal statistics solely.

You can unsubscribe from our mailing list at any time.

Please note that if you would like to become an ACTIVE member of YES (i. e. participating in one of our task forces or regional groups) you need to fill out the respective other registration form available on our website or via this URL: https://goo.gl/forms/3YNaghUTMJ7dt4ng2.

Email address *
First name *
Your answer
Family name *
Your answer
Date of Birth *
Please note, that only ILAE junior, student, or trainee members (i.e., age < 40 or still in training) qualify as regular YES members with a right to vote on the direction of YES.
MM
/
DD
/
YYYY
Are you in professional training? *
Required
Current affiliation
Your answer
Country of origin *
Your answer
Work country *
Your answer
Work region *
Specialty *
You can chose more than one option.
Required
ILAE Chapter (if applicable)
Your answer
How did you hear about YES?
Your answer
Privacy Policy, Newsletter and information via email *
Please state that you have carefully read and understood the ILAE Privacy Policy which you can find here: https://www.ilae.org/privacy-and-security/privacy-policy. Also, please confirm that you want to receive our regular newsletter as well as occasional additional information about YES via email. You can unsubscribe from our mailing list at any time.
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service