Join us!

Fill the following form and send it to the General Coordinator:

Please notice : WE DO ACCEPT ONLY HAM PHARMACISTS: in other words, you MUST be PHARMACIST AND RADIOAMATEUR to join this Group, as clearly exposed in our STATUTE, please DON'T apply if you aren't Pharmacist: we will have to refuse your application. Sorry!

IPHG Joining Form

First Name:

Last Name:

Callsign:

Address Line 1:

Address Line 2:

City:

State/Province:

Country:

Zip/Postal Code:

e-mail:

Job:

University where you graduated:

How did you find this site?

Please write a short biography:

Would you like to receive the Membership Certificate?Yes, pleaseNo, thanks

If you said YES, should I put * Dr. * before your name?YesNo

PLEASE NOTICE: these infos will be published in your page at I.P.H.G. Web Site. If you wish part of these data will be left blank, please write them in (brackets). To avoid you any possible junk mail, we will publish your e-mail address just as a GIF picture. In this way the spambots cannot detect your e-mail address. No information will be given to anybody. The sending of the form equals to accept the pubblication of the data in the I.P.H.G. Web Site.