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Please enter your membership information:
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A.1 Details of applicant
Name of the applying scientist: *
Title of the applicant:
Official name of the institution or site of the applicant:
Country of institution:
PO Box:
Postal Code:
Cedex:
Street name and number:
City:
Country:
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Fax:
Website:
	Yes, I would like to automatically receive the EDCTP Newsletter and any other relevant material. My details will not be passed on to any other party.

A.2 Areas of personal expertise
	HIV/AIDS in general	Malaria in general
	HIV/AIDS Vaccines	Malaria Vaccines
	HIV/AIDS Drugs	Malaria Drugs
	Tuberculosis in general	Epidemiology
	Tuberculosis Vaccines	Microbiocides
	Tuberculosis Drugs	Joint capacity building
	Networking	Monitoring
	Training	Establishment of exchange programmes
	Informal advice on the conduct of clinical trials and capacity building	Joint proposal development
	Joint application for grants	Cofunding for EDCTP grant applications
	Establishment of mentorship programmes	Ethics
	Other:

A.3 Personal profile and work history (max 250 words)

A.4 Description of Proposed Project (Optional)
Project title:
Project scope:
Proposal research plan (maximum 200 words):

B.1 Description of the type of collaboration(s) needed
Description of type of collaboration(s) needed:
	HIV/AIDS in general		Malaria in general
	HIV/AIDS Vaccines		Malaria Vaccines
	HIV/AIDS Drugs		Malaria Drugs
	Tuberculosis in general		Epidemiology
	Tuberculosis Vaccines		Microbiocides
	Tuberculosis Drugs		Joint capacity building
	Networking		Monitoring
	Training		Establishment of exchange programmes
	Informal advice on the conduct of clinical trials and capacity building		Joint proposal development
	Joint application for grants		Cofunding for EDCTP grant applications
	Establishment of mentorship programmes		Ethics
	Other:
B.2 Preferred country(s) for collaboration(s) mentioned in section B.1 above
African countries (reset list):		European countries (reset list):
B.3 Description of partner that you are looking for

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