Application form for Key Stakeholder

Enlarge your network ; Increase your knowledge and opportunities for research funding ; Reinforce your visibility and profile at EU-Pacific level meetings.

Name of Organisation/Institution: *

Status of the organisation: *

Public

Private

Other

Address of the organisation: *

Type of the organisation: *

Political level

Scientific administrative level

Development organisation

S&T organisation/project

Main Scientific field of the organisation: *

Social science

Health

Physical science

Life science

Specific scientific field: *

Other focus: *

Geographical area of studies: *

Website of the organisation: *

Name of the representative: *

Nationality of the representative: *

Occupation/Grade of the representative: *

Brief biography of the representative (professional background): *

Interest in PACE-Net: *

Phone: *

Email: *

Do you have experience in International research ?: *

No

Yes

If YES specify the program: *

What code is in the image?: *

Enter the characters shown in the image.