Association Membership Sign Up Our NetworkApply to be a Member Association Membership Sign Up In this section Association Membership Sign Up ASSOCIATION MEMBERSHIP APPLICATION FORM ASSOCIATION DETAILS Association Name Address Postcode Country Association Website Telephone Email Provide brief summary on Mission, Aims or Goals of Association Membership Eligibility Please select... Researcher Bariatric surgeon Cardiologist Consultant Dietitian Diabetes educators Diabetologist Bariatric physician Endocrinologist Media Advocate Medical officer Nurse Nutritionist Paediatric endocrinologist Patient Physiotherapist Paediatrician Physician Psychologist Population Health Expert Public Health Advisor Other Please select one or more options to be eligible to join your association APPLICATION INFORMATION Number of your current members PLEASE NOTE - MEMBERSHIP FEES ARE $5.00 PER INDIVIDUAL MEMBER EXECUTIVE BOARD INFORMATION First Name Last Name Email Role on the Executive Board Please select... President Vice-President Treasurer Secretary Board Member Other Position Please select... Researcher Bariatric surgeon Cardiologist Consultant Dietitian Diabetes educators Diabetologist Bariatric physician Endocrinologist Media Advocate Medical officer Nurse Nutritionist Paediatric endocrinologist Physiotherapist Paediatrician Physician Psychologist Population Health Expert Public Health Advisor Other Specify Other (Role) Is this also the Administrative point of contact? Yes No If No please fill in the POC ADMINISTRATOR INFORMATION section below EXECUTIVE BOARD INFORMATION First Name Last Name Email Role on the Executive Board Please select... President Vice-President Treasurer Secretary Board Member Other Position Please select... Researcher Bariatric surgeon Cardiologist Consultant Dietitian Diabetes educators Diabetologist Bariatric physician Endocrinologist Media Advocate Medical officer Nurse Nutritionist Paediatric endocrinologist Physiotherapist Paediatrician Physician Psychologist Population Health Expert Public Health Advisor Other Specify Other (Role) POC ADMINISTRATOR INFORMATION First Name Last Name Email Position Please select... Researcher Bariatric surgeon Cardiologist Consultant Dietitian Diabetes educators Diabetologist Bariatric physician Endocrinologist Media Advocate Medical officer Nurse Nutritionist Paediatric endocrinologist Physiotherapist Paediatrician Physician Psychologist Population Health Expert Public Health Advisor Other DECLARATION I declare that: The Association is not-for-profit The Association has similar objectives to that of WORLD OBESITY The Association has a minimum of 15 members I declare that the information I have provided in the application is truthful. Once the Association becomes a member, it agrees to pay the annual membership fee requested by WORLD OBESITY Applicant Name Role of signatory Applicant Signature Date REQUIRED DOCUMENTATION Please ensure that the following documentation is included with the completed application form: Official request to apply for WORLD OBESITY National or Associate membership on behalf of the Executive Committee of the applying Association Letter from the president Association's current constitution Constitution document Sample of any professional publications Alternatively you can send the application and supporting documents to: WORLD OBESITY Membership Charles Darwin 2, 107 Gray's Inn Road, London, WC1 X8TZ United Kingdom Or via Email to Membership@worldobesity.org If you would like to discuss your application, please contact Membership@worldobesity.org or Fiona Montague FMontague@worldobesity.org - WORLD OBESITY's Programme and Membership Manager. Once the application form and associated documents have been received, The Membership Committee, will review the application, it will be then be referred to the Executive Committee with a recommendation to accept or reasons to reject the application. If further information is required you will be contacted. Your application should take a maximum of 2 months to process. Please note that WORLD OBESITY will not be able to process incomplete applications or those missing required documents. Contact Information We do not store credit card details nor do we share financial details with any 3rd parties. Share this page