Thyroid Patient Organization Membership form – Thyroid Federation International

Description:
Open to organizations that provide evidence-based patient information.

Cost:
€60,00 / year (Fee is waived for the first 3 years)

Benefits:
Access to the Annual General Meeting

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Contact Name

Name

First

Last

Phone

Name of Organization

Country

Full Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

When did your group start?

Are you a patient or a medical professional?

Legal status (eg. registered charity, etc):

Do you have employees? If so, how many?

Do you have a management committee/board?

Do you have volunteers? If so, how many?

Names of medical advisors and their position (e.g. general practitioner, consultant, etc)

How many members do you have?

What is the population of your country?

What is the annual membership fee?

Do you have local groups? If so, how many?

Do you have a telephone help-line?

Do you have information leaflets?

What are the goals of your group?

How do you work with the medical profession?

Please provide a brief description of your activities to date:

The working language of the TFI is English. Do you have a representative who can speak English? If not, what languages do you have?

Please provide the name of a thyroid specialist from your country who is a member of one of the following: the European Thyroid Association (ETA), the American Thyroid Association (ATA), the Asian-Oceania Thyroid Association (AOTA), the Latin American Thyroid Society (LATS) so that we can write to them for an endorsement of your activities.

Name of ETA/ATA/AOTA/LATS member

Member of which organization ETA/ATA/AOTA/LATS:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email address

Thyroid Federation International (TFI) was established in 1995. It is a network of patient-support organizations worldwide, working together for the benefit of those affected by thyroid disorders by providing information and raising awareness. TFI assists the formation of patient-oriented groups, encourages high standards amongst patient support groups and works closely with the medical professionals. Members of Thyroid Federation International are expected to:

help publicize Thyroid Federation International
work with medical professionals in their country
share relevant and appropriate information with other TFI members
pay the TFI membership fees each year upon request
sign an annual membership renewal and agreement form
adhere to the principles of TFI
act as an ambassador for TFI and reflect the views of the organization as a whole
treat other members of TFI with respect
abide by the criteria required by the Thyroid Alliance

By signing/inserting my name below I confirm that I have read and understood the above regulations and agree to abide by these. I will notify the Executive Committee of TFI of any changes.

Signing name

Date

Notes:
New members are exempt from payment for 3 years. At the end of the 3 year period, the member must pay the annual membership fee. In the three year period, the member may make presentations at meetings and have the right to vote during the Annual General Meettings (one vote per member).

Contact Name

PROUD MEMBER OF

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