J-WEL | Member request to join

Member request to join

* Required fields are marked with an asterisk

Gender

Title (Prof., Dr., Ms., etc.)

First name *

Middle name

Last name *

Suffix name

University email *

Alternative email

Country of Citizenship *

J-WEL Affiliation *

Job Title *

Keep this blank

I give consent to J-WEL Connector to use this information to build a profile when my request is approved. *