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 Algarve Breast Cancer Congress (CCMA) Friend or family member Other

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

Please send the proof of payment to the following e-mail address: info@mamativa.pt. Only then can we validate your registration.

Note: The 1st annual fee must be paid when you complete this form. After 12 months you will receive an e-mail reminder to pay the following fee.

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

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