DESWARE ON-LINE REGISTRATION FOR INSTITUTIONS

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

Title
*
First Name
*  
Last Name
*  
Organization/Company
Address
City
Province/State
Postal code
Country
Phone Number
Fax Number
Email Address
*   
Confirm Email Address
*
Administrator Details
Name
*  
Email
*   
Phone No
*  
How did you hear about DESWARE
*  
If "Other" please specify
*    
Preferred Username
*  
(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)
*  

Institution IP Addresses and/or Ranges

Domain Name (e.g.www.mydomain.edu)
*   
For Institutional subscribers require an IP Address, please print out the attached PDF version, fill the information and return to the address stated at the end of the page 
Examples of valid IP Addresses
Single Station  :
. . .
Class B Networks  :
. . .
Class C Networks   :
. . .
IP Range  :
. . .  - . . .  or . . .  - . . .
To enter Range address click on the checkbox to enable the second IP address box
1. . . .          . . . *     
2. . . .          . . .     
3. . . .          . . .   
Does your institution have a Firewall Server?


    If yes, enter the IP address of the Firewall Server . . .    

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.
Email - Direct your order and credit card details to: eolssunesco@gmail.com
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.