NIAS Fellow Registration Form - Guests of director

Personal Information

Title

e.g. Prof, Dr, DRS, Mr, Ing, Ir

Name as in passport*

First Middle Last

Preferred name

If different from name in your passport

First Middle Last

Gender*

Male
Female
Gender queer
Rather not say

Date of Birth*

Place of Birth*

Nationality

Second nationality

Home address*

Home postal code*

Home: city*

Home country*

Phone*

Preferably a mobile phone number

Private email address*

Personal email address

Work email address*

You will receive the acknowledgement of receipt on this email address. Make sure this field is filled out correctly.

Link to your personal website

Are you active on social media? If so, please add your social media handles.

LinkedIn	Instagram	Facebook	Other

We would greatly appreciate it if you could mention your affiliation as NIAS-Fellow in your bio once your fellowship has started (linkedin.com/company/nias-knaw, @nias_knaw on Instagram and @niasknaw on Facebook).

NIAS Fellow Registration Form – Guests of director

Step 1 of 4

Personal Information

Work Related Information

Information on your project or research

Fellowship Information

Conduct and data use

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