Translate page

Membership of the iCMLf - Membership Form
  1. Through the work of the iCMLf your support will further the progress towards best possible management for CML patients wherever they reside.

    Please fill out the following form to become a member of the iCMLf. Fields marked with an asterisk (*) are required.

  2. (*)
    Invalid Input
  3. Name:(*)
    Invalid Input
  4. Institution/organisation:
    Invalid Input
  5. Department
    Invalid Input
  6. Telephone
    Invalid Input
  7. Country:(*)
    Invalid Input
  8. E-Mail address:(*)
    Invalid Input
  9. Donate to Specific iCMLf Programs

    As a member of the iCMLf you can also choose to directly contribute to the iCMLf’s most important programs. With your help, we can significantly increase the number of physicians, scientists and patients who are supported through these programs. The entirety of your donation will be applied to the designated program(s) of your choice. This contribution will not be used for administrative costs, which are covered by the iCMLf.
  10. Additional donation(*)

    Invalid Input
  11. (*)



    Invalid Input
  12. (*)
    Invalid Input
  13. Contributions of $500 or more will be specifically acknowledged on the iCMLf website and annual report. iCMLf members contributing over US $1,000 in any one donation will be recognised as a Patron of the Foundation. Thank you for this additional support!

    Payment Methods

  14. (*)

    Invalid Input
  15. {text3:caption}
    {text3:body}{text3:validation}
    {text3:description}
  16. Privacy Policy(*)
    Invalid Input
    Accept Privacy Policy
  17. (*): Required field