ISAH – Form for Country Representatives

Form for Country Representatives

Please fill in all required fields *!

Surname *
First name(s) *
Gender *	Female Male
Title(s) *	Professor Associate Professor Dr Other
If other, please indicate:
Organisation *
Postal Address
ZIP
City *
Country *
Office phone
Mobile phone
E-mail *
Keywords of main scientific activities *
Additional information

Please additionally enter the shown digits:10289

After submitting, the application was sent to:

Christelle Fablet, Secretary
Hermann Schobesberger, Treasurer

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