Membership Form

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Full name * Date of birth ID Number Address Phone number * E-mail *

Occupation Current situation * Select an option Cancer patient Family member of a cancer patient Healthcare professional Other How did you hear about Mamativa? Select an option Social Media Congresso do Cancro da Mama do Algarve (CCMA) Friend or Family Other

Annual membership fee: €15 (payment by bank transfer to IBAN: PT50 0045 7191 4039 7617 8354 8).

Note: The first annual membership fee must be paid upon completion of this form. After 12 months, you will receive a reminder by email to pay the next annual membership fee.

We kindly ask you to send proof of payment to the following email address: info@mamativa.pt. Your membership can only be validated once we have received and confirmed your payment.

I have read and accept the Bylaws of the Mamativa Association. I have read and accept the Privacy Policy. I agree to receive communications from Mamativa.

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