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University cluster membership

Please complete this form to submit your request for membership of EPSO. Once complete, you can also fax (+32-2-213-6269) or mail (European Plant Science Organisation, EPSO, Rue de l’ Industrie 4, 1000 Brussels, Belgium) this form after printing.

Our organisations would like to join EPSO as a university cluster:

Organisation 5

Original name:

Please enter the name of the organisation as it is commonally referred to

Name in English:

Please enter the organisation's name in English, if different from above

Street:

City:

Country:

Telephone:

Fax:

Website:

Approx. number of staff:

Including technical and scientific people, excluding undergraduate students

Scope and expertise:

E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.

Representative of the organisation for EPSO

Name:

Representative's address:

If different from organisation's address

Telephone of representative:

If different from organisation's telephone number

Representative's e-mail:

Function in the institute:

Function in the university:

Science expertise:

Supporting Scientist

Name of supporting scientist:

Supporting scientistic's address:

If different from organisation's address

Telephone of supporting scientist:

If different from organisation's telephone number

Supporting scientist's email:

Function in the institute:

Function in the university:

Science expertise:

Organisation 3

Original name:

Please enter the name of the organisation as it is commonally referred to

Name in English:

Please enter the organisation's name in English, if different from above

Street:

City:

Country:

Telephone:

Fax:

Website:

Approx. number of staff:

Including technical and scientific people, excluding undergraduate students

Scope and expertise:

E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.

Representative of the organisation for EPSO

Name:

Representative's address:

If different from organisation's address

Telephone of representative:

If different from organisation's telephone number

Representative's e-mail:

Function in the institute:

Function in the university:

Science expertise:

Supporting Scientist

Name of supporting scientist:

Supporting scientistic's address:

If different from organisation's address

Telephone of supporting scientist:

If different from organisation's telephone number

Supporting scientist's email:

Function in the institute:

Function in the university:

Science expertise:

Organisation 4

Original name:

Please enter the name of the organisation as it is commonally referred to

Name in English:

Please enter the organisation's name in English, if different from above

Street:

City:

Country:

Telephone:

Fax:

Website:

Approx. number of staff:

Including technical and scientific people, excluding undergraduate students

Scope and expertise:

E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.

Representative of the organisation for EPSO

Name:

Representative's address:

If different from organisation's address

Telephone of representative:

If different from organisation's telephone number

Representative's e-mail:

Function in the institute:

Function in the university:

Science expertise:

Supporting Scientist

Name of supporting scientist:

Supporting scientistic's address:

If different from organisation's address

Telephone of supporting scientist:

If different from organisation's telephone number

Supporting scientist's email:

Function in the institute:

Function in the university:

Science expertise:

Organisation 2

Original name:

Please enter the name of the organisation as it is commonally referred to

Name in English:

Please enter the organisation's name in English, if different from above

Street:

City:

Country:

Telephone:

Fax:

Website:

Approx. number of staff:

Including technical and scientific people, excluding undergraduate students

Scope and expertise:

E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.

Representative of the organisation for EPSO

Name:

Representative's address:

If different from organisation's address

Telephone of representative:

If different from organisation's telephone number

Representative's e-mail:

Function in the institute:

Function in the university:

Science expertise:

Supporting Scientist

Name of supporting scientist:

Supporting scientistic's address:

If different from organisation's address

Telephone of supporting scientist:

If different from organisation's telephone number

Supporting scientist's email:

Function in the institute:

Function in the university:

Science expertise:

Organisation 1

Original name: *

Please enter the name of the organisation as it is commonally referred to

Name in English:

Please enter the organisation's name in English, if different from above

Street: *

City: *

Country: *

Telephone: *

Fax:

Website:

Approx. number of staff:

Including technical and scientific people, excluding undergraduate students

Scope and expertise:

E.g. university, research institute, organisation facilitating research; scientific expertise - ecology, physiology, molecular biology etc.

Representative of the organisation for EPSO

Name:

Representative's address:

If different from organisation's address

Telephone of representative:

If different from organisation's telephone number

Representative's e-mail:

Function in the institute:

Function in the university:

Science expertise:

Supporting Scientist

Name of supporting scientist:

Supporting scientistic's address:

If different from organisation's address

Telephone of supporting scientist:

If different from organisation's telephone number

Supporting scientist's email:

Function in the institute:

Function in the university:

Science expertise:

Other comments:

Completed by: *

Date: *

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University cluster membership

Our organisations would like to join EPSO as a university cluster:

Representative of the organisation for EPSO

Supporting Scientist

Representative of the organisation for EPSO

Supporting Scientist

Representative of the organisation for EPSO

Supporting Scientist

Representative of the organisation for EPSO

Supporting Scientist

Representative of the organisation for EPSO

Supporting Scientist

What's new?

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