Application form

UICC | International Union Against Cancer

Together we are a resource for action, a voice for change

My account services

Application form

Please fill in the following information to apply * = Required fields
Annual membership fees: Members from high-income countries: USD 100.00 per year Members from middle-income countries : USD 50.00 per year Members from low-income countries : USD 20.00 per year The membership annual dues cover a 12 month period.
Personal details
→		Do you already have a username? Sign in first
*	User ID:
*	Password:
*	Re-enter password:
	Preferred language:
	Title:
*	First name:
	Middle name (1):
	Middle name (2):
*	Last name:
*	Email address:
*	Re-enter email address:
	Phone:
	Mobile phone:
	Fax:
Postal Mailing Address
*	Street address:
	Street address 2:
*	City:
*	Country:
*	State / Province:
*	Postal code / ZIP:
Professional information
*	Organization:
	Position:
	Department:
	Website:
References Unless you are a member of the Association of UICC Fellows, it is necessary that you name one person who could recommend your candidacy. Please indicate whether you are a member of the Association of UICC Fellows:
I am a member of the Association of UICC Fellows
If not, please provide the following reference:
	Title:
*	First name:
	Middle name (1):
	Middle name (2):
*	Last name:
*	Email address:
	Phone:
	Mobile phone:
	Fax:
*	Street address:
	Street address 2:
*	City:
*	Country:
*	State / Province:
*	Postal code / ZIP:
Background Please summarize your professional background

Terms and conditions
*		I have read and I accept the terms and conditions of use of this service.