Educational Member Registration Form
  1. Name of Institution(*)
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  2. Address(*)
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  3. Postal Code(*)
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  4. Country(*)
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  5. Primary Representative(*)
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  6. Position Held(*)
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  7. Telephone(*)
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  8. Fax
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  9. Email Address(*)
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  10. Website(*)
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  11. Additional Representatives:
  12. Name of Representative
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  13. Email Address
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  14. Name of Representative
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  15. Email Address
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  16.  
  1. Please state the number of full-time students attending the Institute:(*)
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  2. Please give any brief details of the Institute’s Campus Card System (if applicable):
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  3. Payment Details - Payment by Invoice: Annual Membership Fee per Institution: €150.00
  4. Your Purchase Order No.:
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  5. Please provide details of who this Invoice should be sent to:
  6. Name of Representative:(*)
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  7. Email(*)
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  8. Security(*)
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  9. Submit