Canadian Polar Commission -

Registration Form for CPIN Directory

Please be aware that the information submitted in this form will fall within the public domain. It will therefore be available to the general public.

A:General

This is a New Submission or an Update.

Name:
Affiliation:
Department:
Address:
Province:
Postal Code:
Country:
Telephone:
Fax:
E-mail:
Website:

Specialties:
	OR other

Keyword(s):	Please separate keywords by a comma.

Please list your most recent publications:

1:
2:
3:
4:
5:

B: Current Research

Title:

Project Description: (2 or 3 lines)

Geographic Location:

Source(s) of Support: Organization(s)

Year:
Amount:

Research Partners in Project

Name:
Affiliation:
Address:

Name:
Affiliation:
Address:

Name:
Affiliation:
Address:

Name:
Affiliation:
Address:

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Last updated: 06/01/2005 3:33 PM (ET)
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