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Text File  |  1994-07-08  |  2KB  |  77 lines

  1. Forum Member/Liaison Profile
  2.  
  3.  
  4.  
  5. Participant Status:  [ ] Member      [ ] Liaison   (check one)
  6.  
  7.  
  8. Official Name:            ______________________________________________________
  9.  
  10. Short Name/Acronym:       ____________   (optional, blank if Liaison)
  11.  
  12. Host Organization:        ______________________________________________________
  13.  
  14. Constituency:             ______________________________________________________
  15.  
  16. Technical Expertise:
  17.  
  18.        Operating Systems: ______________________________________________________
  19.  
  20.        System Platforms:  ______________________________________________________
  21.  
  22.        Networks:          ______________________________________________________
  23.  
  24.        Additional:        ______________________________________________________
  25.  
  26. Forum/Liaison Contact Information:
  27.  
  28.        Regular Phone #:   ___________________________     Country Code: ______
  29.  
  30.        Emergency Phone #: ___________________________
  31.  
  32.        Facsimile #:       ___________________________
  33.  
  34.        STU III:           ___________________________
  35.  
  36.        Electronic Mail:   ______________________________________________________
  37.  
  38.        Mailing Address:   ______________________________________________________
  39.  
  40.                           ______________________________________________________
  41.  
  42.                           _________________________________________________________________________________________
  43.  
  44.                           ______________________________________________________
  45. Principal Personnel Information: (for use only within the Forum)
  46.  
  47.        Name of Forum Representative or Liaison: ________________________________
  48.  
  49.        Regular/Emergency Phone #: _____________________________________________
  50.  
  51.        E-mail Address: ________________________________________________________
  52.  
  53.  
  54.        Other team members:
  55.  
  56.        Name: ______________________________
  57.  
  58.        Regular/Emergency Phone #: _____________________________________________
  59.  
  60.        E-mail Address: ________________________________________________________
  61.  
  62.  
  63.        Name: ______________________________
  64.  
  65.        Regular/Emergency Phone #: _____________________________________________
  66.  
  67.        E-mail Address: ________________________________________________________
  68.  
  69.  
  70.        Name: ______________________________
  71.  
  72.        Regular/Emergency Phone #: _____________________________________________
  73.  
  74.        E-mail Address: ________________________________________________________
  75.  
  76.  
  77. Remarks: