EDA membership application

Instructions

We would ask you to fill out the following form. Form fields that are boxed in orange are mandatory.
Please take special note of the instructions in the Payment section below in respect to necessary SEPA direct debit information and consent, and what to do if you cannot use this form of payment.
Once your application has been processed, you will receive access to the EDA member's portal, where you will be able to correct or change your details, and where other services will be available (The EDA member's portal will be available in due course).
Thank you!

This form may contain some German'isms. We ask you to excuse this "misdemeanor", but it shouldn't compromise you registering. The software hosting this form is based in Germany. It is in constant update and we are hoping for a completely translated version soon.

Who you are?

Given name

Surname

Salutation/Gender

Title

Age (years)

If you do not identify with a binary gender, choose an alternative if you wish.

Where you are?

Please give your professional address.
If there is none available or not applicable, give another contact address.

Professional affiliation (i.e. University, Hospital xyz)

Professional affiliation (i.e. Department of xyz)

Professional affiliation (any further information)

Street address / (PO Box if none)

Postal code

Town/City

Country

Contact details

Phone number incl. country code (i.e. +33 (0)123...)

Fax number incl. country code (i.e. +33 (0)123...)

Email address (will be used for all contacts)

Webseite of professional affiliation if available

Further demographics

We would like to know more about you! Providing the following information is in no way mandatory, but would help us in e.g. providing more specific feedback.

Have you been to EDA meetings?

Select your main affiliation

Add more or other affiliations

More/other affiliations

Select your main profession

Add more or other professions

More/other professions

Select your main field of work

Add more or other disciplines

More/other disciplines

Data sharing consent

Information

To share your data with others we need your consent. You can revoke your consent at anytime by logging into the EDA member's portal and changing the settings there (The EDA member's portal will be available in due course).
Why do we ask you to share your data and which data would be shared in the case that you consent?

We would share your data with future EDA meeting organizers - so that they can more easily provide you with a membership discount on registration fees.
We would share your data with other professional delirium organizations (this means the American Delirium Society or the Australasian Delirium Association only) - so that they can provide you with a membership discount on registration fees.
You can choose to consent to either, both or none of the above options individually
Only your name and email addresses would be shared.

Please note, however: In the case you consent to sharing your data as indicated, privacy and data protection will no longer be in the hands of the European Delirium Association e.V. (EDA) - and we can therefore not be made accountable for any potential inadequate use. This responsibility will explictily move to the receiving organizers, institutions or individuals. The receiving organizers, institutions or individuals, however, provide a contractual guarantee that the provided data is used only for the purposes noted.

Share your name and email address with future EDA meeting organizers - so that they can more easily provide you with a membership discount on registration fees.

Share your name and email address with other professional delirium organizations (American Delirium Society and the Australasian Delirium Association only) - so that they can provide you with a membership discount on registration fees.

Membership fees

Information

Membership is granted free of charge for the remainder of the year in the first year of membership – if acquired after the yearly meeting of the European Delirium Association.
If registering for the yearly meeting of the European Delirium Association and simultaneously applying for a reduced fee because of pending EDA membership – the yearly fee will have to be paid.
Membership therefore entitles to reduced registration fees for the next and future meetings.

This notwithstanding, membership fees are annual fees, running from the 1st of January to the 31st of December. If you decide to terminate your European Delirium Association e.V. (EDA) membership, you must do so before the end of November of a given year by written notice to member@europeandeliriumassociation, otherwise membership fees will be due for the following year (see the EDA constitution §4(3) for details).

Type	Description	Annual fee
Normal	Members with above the average* income and avid supporters	50€
Reduced	All others	30€

* Please judge for yourself which fee seems more appropriate – in the context of your profession (e.g. physicians vs. other medical staff), your position within the profession (e.g. consultant, GP, specialist vs. first-year trainee or student) and also in respect to your country of residence’s average income.

Choose your membership fee

Payment

Instructions

To streamline our accounting processess, PLEASE use SEPA direct debit if in any way possible, allowing us, given your consent below, to debit your account to collect recurring membership fees.

Please provide the

Name of the bank account's holder

The bank's name

The bank account's IBAN number

The bank's SWIFT/BIC code

and then check the tick box, authorizing us to carry out the SEPA mandate!

NOTE For non-SEPA compatible bank account holders

If you cannot use SEPA direct debit because e.g. your bank account is not located in a member state of the European Single Euro Payments Area (SEPA), please leave the following form fields BLANK and do not check the tick box.
We will then send you further instructions by email in due course.

Bank account holder (Name)

Name of the bank

IBAN

SWIFT/BIC *

* 11 character SWIFT/BIC codes are required.
Please note that if you only have an 8-character BIC (sometimes also called SWIFT) code, add XXX to the end of your code, giving you 11 characters. Please also make sure that there are no hidden spaces.
E.g: "BELADEBE" would then read "BELADEBEXXX"

By checking the box and thereby signing this mandate form, you 1.) authorise the European Delirium Association e.V. (EDA) to send instructions to your bank to debit your account and 2.) your bank to debit your account in accordance with the instructions received from European Delirium Association e.V. (EDA) - until you revoke this mandate (e.g. by terminating your European Delirium Association e.V. (EDA) membership; see the EDA constitution §4(3) for details).

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.

Privacy and data protection notices & Final consent

I consent to being contacted by the EDA via email for membership, EDA-organisational and other internal issues, such as information on EDA meetings.
Consenting here is a necessary prerequisite for membership, as the EDA communicates paperless. Consent here is distinct from consenting to receiving newsletters or other more general information, or agreeing to other forms of data sharing - see above.

The European Delirium Association e.V. (EDA) provides privacy and data protection for its members' data along the lines of the European General Data Protection Regulation (GDPR). For technical details and a summary of our obligations and your rights, please follow this link.
By providing my consent here, I have acknowledged having read the information provided and agree to the conditions outlined therein.

NOTE

Please check the information you have entered here now.
You will be able to download a PDF form with your details for your reference after submitting (it will also be sent to you by email).
If any of the information turns out to be erroneous, you will be able to correct the details on the EDA member's portal after membership is granted (The EDA member's portal will be available in due course).

I confirm that the above details - to my best knowledge - are correct.