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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 fax to:
Dr.-Ing. Thomas Jordan
Institute for Nuclear and Energy Technologies IKET
Forschungszentrum Karlsruhe GmbH
Hermann-von-Helmholtz-Platz 1
76344 Eggenstein-Leopoldshafen
Germany
Tel. +49 7247 82 6105
Fax +49 7247 82 4777
Email info@hysafe.net
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Organization details:

  1. Name of Organization .......................................................................................
  2. Department (if applicable) ................................................................................
  3. Type of Organization (Industry, research Centers or Universities), others ........ .........................................................................................................................
  4. Country............................................................................................................
  5. Office address................................................................................................... ......................................................................................................................... .........................................................................................................................
  6. Office Phone......................................................................................................
  7. Office Fax..........................................................................................................
  8. Website.............................................................................................................
  9. Name of Contact Person....................................................................................
  10. Phone................................................................................................................
  11. Email Address....................................................................................................

Applicant’s details (to be completed only if private person applies for membership):

  1. Name, Surname .................................................................................................
  2. Date and place of birth .......................................................................................
  3. Gender...............................................................................................................
  4. Nationality.........................................................................................................
  5. Country of Residence.........................................................................................
  6. Address/City/Town/Postcode:.......................................................................... ..........................................................................................................................
  7. Mobile phone:....................................................................................................
  8. Contact email:....................................................................................................
  9. Scientific degree.................................................................................................
  10. Education, occupation, position ........................................................................ ...........................................................................................................................
  11. Scientific area.....................................................................................................
  12. Interest in Hydrogen safety activity...................................................................

Membership is open to legal entities and private persons interested in hydrogen safety.

 

Membership fees:

Full Membership for large and medium industry and research institution, associations: 3000 €
Associated membership: 1500 €

Full Membership for small industry and research institution, Universities: 1500€
Associated membership: 750 €

Private person (as associated member only): 100 €


I, herby, apply the admission to IA HySafe

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Signature of applicant


The association reserves the right to refuse membership applications. The applicants will be informed accordingly.