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1. APPLICANT DATA for Internet Society Global Chapter Workshop and Global INET (April 2012)

 
 25% of survey complete.
Information about the 2012 Global Chapter Workshop and the Global INET


IMPORTANT NOTE TO APPLICANTS

* This Travel Fellowship Programme requires that the candidate selected has been discussed and agreed by Board members of the Chapter.

* Completing this application form does not mean that your Travel Fellowship application is accepted. It is subject to review and approval by Internet Society staff.

This application form is in ENGLISH only. If you need help translating the application form, please contact Chapter Support at chapter-support@isoc.org.


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* 1. First Name:

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* 2. Last Name:

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* 3. Male / Female

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* 4. Please tick the box below that corresponds to your age range

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* 5. Please provide your email address

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* 6. Please provide a contact number: can be phone, cell or instant messaging ID (optional)

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* 7. Please provide your Internet Society (ISOC) Membership ID.
NOTE: If you do not know your Membership number, please login to https://portal.isoc.org/
to review your membership profile "My Account" -- "View Profile".

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* 8. Do you have any special needs?

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* 9. What is the name of the Chapter you are a member of?

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* 10. What is your role in this Chapter?

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