PASCAR Institutional Membership Form

PASCAR Institutional Membership Form
Dear President,

Thank you for your interest in joining, renewing, or updating your PASCAR institutional membership.
As the continental organisation representing cardiology across Africa, the Pan-African Society of Cardiology (PASCAR) affiliates with national, cardiology-focused institutions such as cardiac societies, associations, and foundations. Where more than one such entity exists in a country, the national cardiology or cardiac society (or association) will be considered the primary institutional partner.

We kindly ask that you take a moment to complete the PASCAR Institutional Membership Form linked below, to ensure we have accurate and complete information on your organisation.

Please note that an annual membership fee of USD 250 is applicable and will be invoiced accordingly. The PASCAR office will follow up with further details regarding the financials and any additional requirements.
We appreciate your continued commitment to advancing cardiovascular health across Africa.

PASCAR President
Full Name of Cardiac Society/Association/Foundation*
Official Society/Association/Foundation Abbreviation*
i.e. PASCAR
Structure*

SocietyAssociationFoundationOther
Our country medical fraternity primary language/s:*

ArabicEnglishFrenchPortugueseOther
Country*
Telephone (include international code)*
Form Submitter’s Email Address*
example@example.com
Organisational E-mail Address*
example@example.com
Organisational Website Address
Other Social Media (if Applicable)
Physical Address (For invoice purposes)*
Brief History of Organisation*
Short Overview of Organisation (incl. Mission and Vision) *
Attach High Resolution Organisation logo (pdf, png, jpg)*

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Names of Members of Board/ Trustees/ Executive*

	Title, Name, Surname	Email Address	Mobile Number
President
Vice-President
Secretary
Treasurer
Executive Officer/ Admin
Exco Member
Exco Member
Exco Member
Exco Member

The current Society Executive Committee Term in Office ends:*

DayMonthYear
Date
The Society would normally have the following number of members *
Please indicate payment method

Payment by Electronic Fund Transfer (proforma invoice will be issued but can be ignored if your society is fully paid-up)Payment in cash (USD) at the next PASCAR ConferenceI formally request a waiver or reduction of the annual membership fee due to financial considerations
Indicate Financial Considerations*

General financial hardship affecting our country/societyOngoing civil unrest or conflict in our country or regionCurrent inability to make foreign financial transactions
Should be Empty: