Membership form - CERCiência (Science Network)
Welcome!

Thank you for your interest in becoming a member of Cerciência (Science Network).

After fillin in this form, you will be contacted by Cerciência with information about the payment of the fee and subsequent confirmation of registration.

For further information, please contact Cerciência
(e-mail: cerciencia@gmail.com / telephone: +351 93 37 56 154)

Scientific regards!
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For the purpose of
Name
Date
MM
/
DD
/
YYYY
Member nr. (fiil in if you are renewing your enrolment or altering your information)
Birth date
MM
/
DD
/
YYYY
Full address
Identification document and number
Telephone number
E-mail address
Qualifications
Academic education and trainig
Occupation
Category of member and correspondent anual affiliation fees
Registration fee: 5€ - payed once, at the time of registration of a new member or at the time of renewal of registration for former members, along with the anual fee. Please send a copy of a document proving your situation as a student or as a collectiva/legal person (i.g. if you are registering a company as member) to cerciencia@gmail.com
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