APPLICATION FOR MEMBERSHIP

Mailing address:

      Male      Female

Applicant's professional category:


 Physician
 Epidemiologist
 Hygienist
 Engineer
 Ergonomist
 Toxicologist
 Psychologist
 Nurse

Educational and previous professional experience:

Proposers (The membership must be endorsed by 3 members of ICOH)


1

2

3

4


For questions regarding membership, please contact:

Diana Gagliardi MD, PhD
C/o INAIL, Research Area
Department of Occupational and Environmental Medicine, Epidemiology and Hygiene
Via Fontana Candida, 1
00078 - Monteporzio Catone (Rome)
Italy
Phone: +39-06-94181506
Fax: +39-06-94181556
E-mail: icoh@inail.it