Become a member

Contact details

First name *

Last name *

Hospital/Center *

Additional hospital/center (if applicable)

Phone (private)

Phone (work)

Email address *

Picture

Additional details

Profile/Function (multiple answers possible)

Working percentage
optional

Since
optional

IBD nurse

IBD study nurse / study coordinator

IBD dietitian

IBD psychologist

Nurse with interest in IBD

Other paramedical professions with an interest in IBD

Language *

Patient population

Adults Children Other

Membership

I want to be a supportive BINAstoria member *

Yes No

I want to be an effective BINAstoria member (with voting rights) and I will be present at the annual general assembly *
(only for IBD nurses/study nurses/study coordinators)

Yes No

Privacy Policy

I declare that I have read and accepted the Privacy Policy *

Intended use

BIRD Group NPO uses the provided personal information for the registration of their members.

If you have any questions on the way we protect your personal data, you can get in touch with us by emailing to:
jenifer.king@birdgroup.be

Your rights

All personal data collected from individuals will be held securely (only accessible by members with a user account and password) and will only be used for the purpose stated above.
You have the right to request a copy of the information we have on you.
You can ask for a correction or deletion of the information we have on you.
You can ask us to stop using your contact information and photograph at any time, in which case it will not be used for future purposes, but this does not affect the lawfulness of the publications before the withdrawal of your consent.

I declare that I have read and understood my rights *

Declaration of consent

I give permission to BIRD Group NPO to the (un-remunerated) use of the photographic
images and / or contact details for the purpose described above *

Yes No

I hereby consent to the use of my contact details and picture on the internal platform
of BIRD/BINASTORIA Group NPO's website *

Yes No

I hereby consent to the use of my

Name and affiliation Email address Picture Function Start date of your function (will not be made publicly available) Patient population Language

On the publicly available part of the website *

Yes No

I give my consent to BIRD/BINASTORIA to share my email address with other BIRD/BINASTORIA members
in order to contact me for ongoing and future studies, projects and events *

Yes No

I give my consent to BIRD Group NPO to share my email address with non-BIRD members
in order to contact me for ongoing and future studies, projects and events *

Yes No

Information

I would like to be kept up to date on the activities of BIRD Group *

Yes No

Become a member

I want to become a BINASTORIA member

Contact details

Additional details

Membership

Privacy Policy

Intended use

Your rights

Declaration of consent

Information