Institution registration

Institution
Subscription date (mm/dd/yyyy)
Institution name
Institution type	University Business school Engineering school Other selective school
Creation date of institution (mm-dd-yyyy)
Yearly budget
Phone number
Fax number
Postal address
Zip code
City:
Country

Legal representative *
Last Name
First name
Position title
Email address
Phone number
Postal address
Zip code
City
Country
(*) By legal Representative, the AXA Research Fund means the senior officer i.e. the highest operational representative of the Research Institution. Depending on the institution and the country, he/she may be Vice-Chancellor, Chancellor, Rector, chaiman of the Board of Directors, President, Director General.

Institution operational contact for AXA Research fund designed by legal representative
Last name:
First name:
Position title
Email address
Phone number
Fax number:
Postal address
Zip code
City
Country

I, legal representative, certify the exactitude of the data and that the operational contact is authorized to contact AXA research Fund on behalf of the institution