Membership Application – PSCC Connect Association-PSCC

Membership Application – PSCC Connect Association

For information: PSCC Connect membership applications are reviewed and approved by the association's President and Executive team, then ratified by the Board of Directors.

Organization wishing to become a member

Organization Name:

Type of organization (PME, ETI, LSE)

Legal form:

If "other", please specify :

SIRET number (RNA number for associations):

Preferred Membership Category:

If you have chosen one of the Biotech-Medtech SME / ETI / LSE colleges, could you specify your field of activity?

If you have chosen Biotech-Medtech SME college, could you tell us when your company was founded?

If you chose the Biotech-Medtech SME or ETI college, could you tell us about your workforce?

Briefly describe your organization (to share with other PSCC Connect members in the association directory):

Your organization's contact information (to share with other members in the directory):

Organization Address :

E-mail

Phone Number

Legal Representative of the Organization

Person authorized to act on behalf of the organization to become a member of the association:

Last Name

First Name

Position in the organization

E-mail

Phone Number

Do you agree to share this information in the PSCC Connect directory of members? (The association does not share this information outside of its members).

YES

The representatives of the structure within the PSCC

One permanent representative and one substitute must be designated to represent your organization within PSCC Connect.

Permanent representative (to fill in if different from legal representative of the organization)

Last Name

First Name

Position in the organization

E-mail

Phone Number

Do you agree to share this information in the PSCC Connect directory of members? (The association does not share this information outside of its members).

YES

Substitute

Last Name

First Name

Position in the organization

E-mail

Phone Number

Do you agree to share this information in the PSCC Connect directory of members? (The association does not share this information outside of its members).

YES

PSCC processes the data collected to manage the membership process and its follow-up, in compliance with the "Informatique et libertés" law of January 6, 1978 and the General Data Protection Regulation (GDPR). The recipients of this information are PSCC employees. To know more about the management of your personal data and to exercise your rights, please contact contact@parissaclaycancercluster.org.

I certify that the information provided is complete. I have the legal capacity to bind the structure described above and hereby confirm our wish to become a member of the PSCC Connect association.