International Human Rights Commission

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IHRC Humanitarian Doctor

APPLICATION FORM

A-PERSONAL INFORMATION

Give Name*

Surname*

Date of birth *

Place of birth*

E-mail*

Repeat E-mail*

Gender

Male
Female

Profeession*

Institution*

Mobile ( +....)*

Phone # (Home) (+...)

Scan of the passport*

Your signature scan*

Your current picture*

Your photo for website*

Home address*

Website Social Media

Have you ever been punished trought court ?*

YesNo

B-MOTIVATION

(Please write clearly. You can use extra sheets if needed)

C-DATA DOWNLOAD FOR INFORMATION DOWNLOADING DIRECTLY FROM A PERSON

Consent to the processing of personal data*

Pursuant to Article 6.1 of REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL (EU) 2016/679 of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46 / EC (general data protection regulation) I, the undersigned, agree to the processing of my personal data regarding my participation in the SMM IHRC volunteer service by the International Human Rights Commission Foundation - IHRC, Intergovernmental Organization (IGO) with the seat, Uraniastrasse 34, 8001 Zürich, Switzerland

CH-020-7002502-3 to update documents, conduct activities and correspondence.

Please be advised that your consent may be revoked at any time by sending an e-mail to the address of our Foundation (office@ihrchq.org )

I agree

Statement*

I hereby certify that all the personal data provided in this application are true and correct. The above requested data are collected for purposes relating to the selection of International Human Rights Commission membership ONLY.

I apply for membership as IHRC Special Medical Member- Humanitarian Doctor of the International Human Rights Commission Foundation – IHRC, Intergovernmental Organization CH-020-7002502-3 and agree to abide by its Constitution and rules.

I agree

Electronic signature ( Name and surname)*