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REGISTRATION FORM

Individual membership n



        Fields marked with * must be filled in!



 
n General and contact information
* Title:
* Last name:
  Middle name:
* First name:
* Gender:
* Date of birth (format: DD-MM-YYYY)
* Country of origin:
* Country of residence:
* City of residence:
* E-mail:
  Webpage:
n WAYS membership
* Membership categories:
* Scientific Departments: (choose at least one)
n Member profile
Education Sector
* Education/Scientific level:
  Institute:
  Current program, grant, fellowship etc.
From (format: DD-MM-YYYY)
Till (format: DD-MM-YYYY)
Work Sector
* Primary working sector:
  If other, please specify
  Primary position:
  If other, please specify
  Secondary working sector:
  If other, please specify
  Secondary position:
  If other, please specify
  Working place:
Scientific Relevance
* Highest degree:
* Discipline:
  Current research topic:
  Most important publications:

  Prizes/awards/honors:  in 
 in 
 in 
n Miscellanous
* Languages:
(at least one)

  Additional info:
n Recommendation for individual members/organisations
You may invite your young colleagues or other potentially interested people to join WAYS by simply filling in this recommendation part.
  Last name:
  First name:
  E-mail:
  Last name:
  First name:
  E-mail:
  Organisation:
  Contact:
  E-mail:
n Authentication
* User Name:
* Password:
* Confirm password:



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