The membership fee will be set after the first meeting of the Association’s bodies, in accordance with § 24 and § 30 of the Statute. Submitting a declaration before then does not create an obligation to pay the fee. See the Statute.
Thank you — your declaration has been submitted
Information on the processing of personal data
Controller: until the Association is entered in the National Court Register, data are processed by the Founding Committee of the Association of Coordinated Care Employers through the secretariat run by the Healthcare Poland Foundation (KRS 0001066269), contact: global@healthcarepoland.pl; after registration — the Association. Purpose: considering the declaration, keeping the register of members and contact on the Association’s matters (Article 6(1)(b) and (f) GDPR). Data are stored for the period of membership and until the expiry of limitation periods for claims. You have the right to access your data, to rectification, erasure, restriction of processing, to object and to lodge a complaint with the President of the Personal Data Protection Office (UODO). Providing data is voluntary but necessary to consider the declaration.
Printable version (paper declaration)
1. Membership category
- ☐ ordinary member — employer within the meaning of § 1a of the Statute (§ 7)
- ☐ supporting member — employers’ organisation, technology entity, other legal person, natural person or expert (§ 8)
2. Entity details
| Full name | |
|---|---|
| Legal form | |
| KRS / NIP / REGON | |
| RPWDL register number (if applicable) | |
| Registered office address | |
| Number of people working (including employees) |
3. Authorised and contact persons
| Person authorised to submit the declaration | |
|---|---|
| Basis of authorisation | |
| Contact person | |
| E-mail and phone |
4. Declarations
1. I apply for admission to membership of the Association of Coordinated Care Employers in the category indicated in point 1.
2. I declare that I have read the Statute of the Association adopted on 24 September 2026 and undertake to comply with it and with the resolutions of the Association’s bodies.
3. I declare that I am authorised to submit this declaration on behalf of the entity indicated (Article 7(2) of the Act of 23 May 1991 on Employers’ Organisations; § 7 of the Statute).
4. I acknowledge that the membership fee will be set after the first meeting of the Association’s bodies, in accordance with § 24 and § 30 of the Statute. Submitting the declaration before then does not create an obligation to pay the fee.
5. I acknowledge that admission is decided by the Director General on the basis of the candidate’s application with a recommendation of at least one Founding Member (§ 9 of the Statute), and that the Association acquires legal personality upon entry in the National Court Register (§ 3 of the Statute).
| Place and date | |
|---|---|
| Signature and stamp |
5. Recommendation of a Founding Member (§ 9 of the Statute)
I recommend the admission of the entity indicated to membership of the Association.
| Founding Member (name) | |
|---|---|
| Representative | |
| Date and signature |
