Affiliate Application form

Please complete and return to Ms. Disha Kohli (d.kohli@iau-aiu.net)

1.	Applying Organization

Name of Organization:
Acronym:
Postal mail address:								
Country: 
Telephone:
Fax: 
General email:
Website:
Social Media:			

2.	Executive head of the Organization (main contact)	
			
Position (Secretary General, President etc.):
Title (Prof, Dr. Ms. Mr. etc.):
Name:
Gender (M/F):
E-mail: 
Phone: 
Period of Mandate if applicable: 

3. 	Deputy (second contact)	

Position:
Title (Prof, Dr. Ms. Mr. etc.):
Name:	
Gender (M/F): 
E-mail: 
Phone: 
				
4. 	Public Relations Officer 

Position:
Title (Prof, Dr. Ms. Mr. etc.):
Name:
Gender (M/F): 
E-mail: 
Phone: 	

5. Date of foundation and brief history of the organization:

…

6. Legal status of the organization:  

…

7. Governing structure:

…

8. Mission and main activities:

…

9. List of members (or link to online list of members):

…

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