BECOME A MEMBER

of Swiss PKU

Become a member of Swiss PKU and support the interests of people with PKU and their families.
As a member, you’ll be invited to our annual general meeting, receive the ‘Phe Tipp’ newsletter
and benefit from other activities of the association.

DECLARATION OF ENROLMENT

TYPE OF MEMBERSHIP

Family

Individual membership/Person with PKU

Passive membership

FIRST NAME *

LAST NAME *

PROFESSION

STREET *

POSTAL CODE / PLACE OF RESIDENCE *

PHONE NUMBER

MOBILE NUMBER

E-MAIL ADDRESS *

BIRTHDATE *

METABOLIC DISORDER

NUMBER OF CHILDREN *

REMARKS

General information

Membership fees
The annual membership fee for individual and passive membership as well as family membership is CHF 100 per year.
Persons with PKU aged 18 and over pay no membership fee.

Membership fee *

By sending this declaration of enrolment, I agree to pay the annual membership fee of 100.00 Swiss francs. Persons with PKU aged 18 and over are exempt from the membership fee.

Agree

Forwarding of contact details *

I agree that my/our address may be shared with the association members for the purpose of contacting me/us:

YES

Captcha *

For security verification, please enter any random two digit number. For example: 36