IBIS Personal Data Directory

Sign-Up Form

Please fill in this form to register (or modify your previous entry) in the IBIS Personal Data Directory.

Any field except FAMILY NAME may be omitted. If reasonable, institutions rather than persons may also be included into the directory. In this case, FAMILY NAME should be the (short) name of the institution.

FAMILY NAME:    FIRST NAME:    TITLE:

AFFILIATION:

STREET: ZIP CODE:

CITY: STATE: COUNTRY:

TELEPHONE NUMBER: TELEFAX NUMBER:

TELEX NUMBER: E-MAIL ADDRESS:

Private address and data:

STREET: ZIP CODE:

CITY: STATE: COUNTRY:

TELEPHONE NUMBER: TELEFAX NUMBER:

FIELD(S) OF INTEREST:

HOBBY:

DATUM: TIME ZONE:

To submit, press:

To clear, press:

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