DESWARE ON-LINE REGISTRATION FOR INDIVIDUALS

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1. CONTACT INFORMATION
(Note: Type NA, if the field not applicable)

Title
*
First Name
*  
Last Name
*  
Organisation/Ins
Email Address
*    
Confirm Email Address
*
Address
City
Prov/State
Postal code
Country
Phone Number
Fax Number
How did you hear about DESWARE
*  
If "Other" please specify
*  
Preferred User Name
*    
(Username must be between 6 - 12 characters with no blank spaces)

2. PROFILE - Activity

Please select the one response below which best describes your activity:
If "Other" please specify:
Primary Job Function
If "Other" please specify:
From the list of subject categories below please select the ONE which best describes your area of work or study

3. PAYMENT

Select Plan
Amount
 
Mode Of Payment
Credit Card Type
Cardholder Name
*  
* You must type creditcard number without blank spaces or hyphens
Credit Card No
*    
Card Identification No
 (For information on card identification number, click here)
Expiry Month
*
Expiry Year
*
Draft No
*  
IssueBank
*
IssueDate(mm/dd/yyyy)
*  
Thank you for your order
For your convenience, subscription will be automatically renewed until you request cancellation.
[For cancellation, send an email to eolssunesco@gmail.com]
Alternatively:

A downloadable Registration Form in PDF or Word is available.

Please fax/mail the form to UNESCO-EOLSS Joint Committee Secretariat
UNESCO-Encyclopedia of Life Support Systems (EOLSS)
E-mail: eolssunesco@gmail.com / eolss2012@gmail.com

By Mail - Bank drafts payable to UNESCO-Encyclopedia of Life Support Systems (EOLSS)
Drafts must be in EUROS/UKP/UK$. International money orders are also accepted.
Please read the following carefully:
I understand that completion of this form is a binding agreement and I offer my personal e-mail address in lieu of a signature:
OR Print and Fax with your signature.
NOTE:
Please use an active email address when registering to EOLSS. An activation email will be sent to the email address associated with your account to provide you access to the service. Please also ensure that any email spam filters are properly configured to ensure that you recieve the activation email from EOLSS.
UNESCO-EOLSS Joint Committee Secretariat

UNESCO-Encyclopedia of Life Support Systems (EOLSS)

E-mail: eolssunesco@gmail.com / eolss2012@gmail.com