Organization details
Member name within ICLAS
*
Website
*
Number of members
*
Role and aims
*
Contact person for Billing Purposes
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Please use the following format: +32479951202
Password
*
A system is in place to remind you of your password and automatically log you in when possible.
Head of your organization
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Please use the following format: +32479951202
Contact person for ICLAS matters
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Please use the following format: +32479951202
Billing Address
Billing Address
*
Membership
Type of Membership applied for
*
– Select –
Affiliate
Associate Silver
Associate Bronze
Associate Gold
Associate Platinum
Institutional
National
Scientific (< 250 members)
Scientific (250-750 members)
Scientific (750 – 1000 members)
Scientific (> 1000 members)
Union
Spam Prevention