APPLICATION FOR HUGO MEMBERSHIP

1.	Name of applicant:	______________________________________________________
(Please print your title, full name and qualifications)
                                                                                                                                                                                                                                                                                                                                                                                                                                             
Full address:		______________________________________________
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         				______________________________________________
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Country:	  	______________________________________________

Tel:	_______________________	Fax:	____________________________

Email:	__________________________________________________________

2.	Please attach to your application a one-page curriculum vitae and list of up to five publications.

3.	Please provide below a brief statement (2 or 3 sentences) of your research interests: 
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4. 	     SUPPORT FOR APPLICATION 
            This application is supported by the following two members of HUGO:

      1______________________________________________________________
		Signature				Name (please print)			Country

      2______________________________________________________________			Signature				Name (please print)			Country

5.	STATEMENT BY APPLICANT                                                                                                           
         I wish to become a member of HUGO and, if granted membership, shall endeavour to give 
         HUGO the benefit of my knowledge and experience:
                                                                                                                                                                
       　Signature of applicant:	______________________________	Date:	____________