By signing (typing your legal name) in the space below, you agree to the collection, use and processing of the personal information you provide to ICTYN in this form for the purposes of organization administration and inclusion of your contact information in a members’ directory that will be distributed to members and staff of ICTYN and key project partners.
By signing, you are also certifying that all information is correct and that you are the person completing this application. You also agree that your information may be accessed and used by ICTYN and its staff. You agree to notify ICTYN Staff of any change to your personal information and make requests to check, delete or correct your personal information, so that it is accurate and current. You understand that the majority of the data requested in this application is necessary for administrative and planning purposes and that the failure to provide this information may prevent your application from being properly processed or the inclusion of your contact information in the members directory.