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* 1. Name

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* 3. Work Phone (optional)

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* 4. Can AIIHPC retain your details?

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* 5. Your current role or position or situation

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* 6. Organisation where you are employed or are a student

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* 7. If you are an undergraduate or postgraduate student, please detail at what level e.g. Masters or PhD

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* 8. Organisation address / where you are based

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* 9. What are your areas of research interest, and/or any current research projects?

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* 10. Can your details be shared with ECRF members?

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* 11. Would you like to sign up to the AIIHPC Newsletter

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