Join ZUGHAM

Please fill out and submit the form below:

Titel / Name / Surname:

Date of birth:

Office address:

Phone / Fax:

E-mail:

Private address:

Phone / Fax:

E-mail:

Date of state examination:

Date practice opened:

Member of the Medical Society of the Canton of Zug (membership is a requirement):

Yes

I have applied for membership

Member Family Doctors Switzerland mfe (membership is a requirement):

Yes

I have applied for membership

Education:

I hereby apply to become a full member of ZUGHAM.

By checking the box above, you acknowledge our bylaws.

Date request:

Personal data will be treated confidentially.