Please fill this form so we can have more info about any workgroup member and
we will know if and how it is possible to work via web.
Personall adress will not published and will be used only for this initiative.

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Thanks.

Name *
Surname *
Organization
Position
Address *
City *
State/Country Zip
Contact Ph:
Email *
Web
Next info need to better understand how to e-communicate
Hardware LapTop Webcam Wi-Fi
OS
-indicate primary-		 Mac Windows Linux
Chat by MSN Ichat AIM Skype
Nickname
Please tell us if you are ICOM member and if you are also member of other associations.
Member of:
ICOM Member* Yes No
Year of birth
Group name? Young Professional Committee
New Professional Committee
Young & New Prof. Committee
Young Museum Professionals C.
Future Museum Leaders Com.

Comments:
* = Mandatory field

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