EURASIAN SILK ROAD UNIVERSITIES CONSORTIUM
	INSTITUTIONAL MEMBERSHIP FORM

APPLYING INSTITUTION
Full Name of Applying Institution :
Abbrevition for Applying Institution :
Address :
City :
Country :
Legal Status (public or private/other) :
Phone :
Fax :
E-mail :
Web :

HEAD OF INSTITUTION
Title :
First Name :
Middle Name :
Last Name :
Address :
Phone :
Fax :
E-mail :

CONTACT PERSON FOR ESRUC
Title :
First Name :
Middle Name :
Last Name :
Address :
Phone :
Fax :
E-mail :
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