New Member States Cluster membership

Request for membership to EPSO

Our organizations would like to join EPSO as a New Member States Cluster:

Please complete this form and send to us by:
e-mail: (Nadia.Khawaja@epsomail.org), or
fax: (+32-2-213-6269), or
post to: 
European Plant Science Organisation (EPSO),
Rue de l’Industrie 4,
1000 Brussels, Belgium.

1. Information on Primary Contact for New Member States Cluster:

Name of the organisation:
(English version of name also - if applicable):
 

Address of the organisation:
Street:
City:
Country:
Tel./Fax, Web;

Scope and expertise of the organisation:
E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.)

Representative of the organisation for EPSO:

Name:
Address: (if different from above):

Tel / Fax:

E-mail:

Function in the Institute or University:

Science expertise:

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students):

2. Information on New Member States Cluster Partners

(Please, identify 3 to 5 cluster partners in your country and indicate 1 supporting scientist per cluster partner)

Partner 1:
Name organisation:
Name Supporting Scientist:
Address:

Tel / Fax:
E-mail:
Function in the institute:

Function in the university:

Science expertise of organisation:

Science expertise of supporting scientist

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students)

Partner 2:
Name organisation:
Name Supporting Scientist:
Address:

Tel / Fax:
E-mail:
Function in the institute:

Function in the university:

Science expertise of organisation:

Science expertise of supporting scientist

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students)

Partner 3:
Name organisation:
Name Supporting Scientist:
Address:

Tel / Fax:
E-mail:
Function in the institute:

Function in the university:

Science expertise of organisation:

Science expertise of supporting scientist

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students)

Partner 4:
Name organisation:
Name Supporting Scientist:
Address:

Tel / Fax:
E-mail:
Function in the institute:

Function in the university:

Science expertise of organisation:

Science expertise of supporting scientist

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students)

Partner 5:
Name organisation:
Name Supporting Scientist:
Address:

Tel / Fax:
E-mail:
Function in the institute:

Function in the university:

Science expertise of organisation:

Science expertise of supporting scientist

Approx. number of staff:
(including technical and scientific people, but excluding undergraduate students)

3. Other comments
 

Date: