Application Form to join Eduserv as an Associate Member
Organisation Name:
Web address
Contact Details (Mandatory): This person will represent your organisation on licensing matters and will
receive information from Eduserv about Chest Agreements by emails, e-newsletters and mail. It is useful
if you can provide details of a second person to act as a deputy. You can divide responsibility for
software and data between the two contacts.
Name:
Job title:
Address:
Telephone:
email:
Responsibility:
For software, data or both?
Second Contact Details:
Name:
Job Title:
Address:
Telephone:
email:
Responsibility:
For software, data or both?
Agreement(s) of interest - please state which of our licence agreements are of most interest to your
organisation:
Source(s) of Funding - please indicate the main source of funding for your organisation:
Status - please answer the following questions:
Is your organisation a registered charity? If so
please supply the registration number.
Is your organisation a commercial incorporated
limited company (profit making) or a company
limited by guarantee (not for profit)? Please
provide your company registration number.
Does your organisation raise a profit? If so, how
is this profit used/distributed?
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Status - please answer the following questions:
Is your organisation a limited company?
Is your organisation involved in education? If
so, in which sector?
Is your organisation wholly resident in UK? If
not, please indicate other countries
Please add any other information which
describes your status
Organisation Mission Statement:
Please indicate any links your organisation has with the teaching and/or research communities:
Please clarify why you think that your organisation should be considered for Associate Member
status:
If accepted as an Associate Member, this organisation agrees to abide by the terms and
conditions of any licences that it subscribes to. Also, that these details can be shared with
relevant suppliers of Chest Agreements for the purposes of establishing whether your
organisation can participate in these agreements.
Signed:
Position:
Date:
Please return form to:
Eduserv Help
Royal Mead
Railway Place
Bath
BA1 1SR
Fax: 01225 474301
We will let you know by email within a few days of receipt of your application if your application has been
successful or otherwise.