Step 2: Submit Data

General Information:

Organization Name:

Year Founded:

Number of Members:

Organization's Purpose:


(In English please; Limit to one brief sentence)

Contact Information:

Contact Person:

First Name:

Middle Name:

Last Name:

Contact's E-mail Address:

Organization's Primary Mailing Address:

Line 1:

Line 2:

City:

State:

(If non-United States, please enter State or Province here: )

Postal Code:

Country:

Phone Number (Including Country Code):

Fax Number:

Organization's Primary E-Mail:

Web -address:

Activities and Resources:

If the Organization has regular meetings or conventions:

What is the frequency of meetings?

In what group of months are meetings usually held?

Does the Organization offer:

Grants or Fellowships?
Yes
No

Awards, Prizes or Honors?
Yes
No

May anyone join the organization?

(If membership is by invitation or nomination only, please check "No.")
Yes
No

Is there a membership or subscription fee?

Yes
No

Does the Organization produce one or more journals, newsletters, or other serial publications?

Yes
No

If Yes, please enter the title(s) of each publication:
(Enter each title on a separate line)

What is the Organization's approximate annual budget (in US Dollars):

How many paid, FULL-TIME staff members does the Organization employ? (Full-Time means an employee who works more than 20 hours per week.)

How many paid, PART-TIME staff members does the Organization employ? (Part-Time means an employee who works 20 or fewer hours per week.)

Brief Description

You may offer a brief description of your organization and its special features. Feel free to mention information not collected elsewhere on this form. Due to space restraints, this description may be edited. Please limit your description to a

single paragraph of 3 to 4 sentences
, or appproximately 50 words.

Your group's primary Focus/Research Interest:

You may choose one keyword from each category. You may skip any or all of the categories. The more words you choose, the more specific and precise the description. If you do not wish to specify any subject, please tick the check box below.

Era:

Region:

Branch of Science:

Topic:

Organization is interested in all aspects of the history of science, technology or medicine. (If checked, do not use the drop downs above.)

Paid Employees

If your organization has regular, paid employees who are involved with the history of science, please list them below. Include their name, e-mail address, and research interest, as described by our standardized system (see above).

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History of Science Society

440 Geddes Hall
University of Notre Dame
Notre Dame, IN 46556
USA
574.631.1194
574.631.1533 Fax
Info@hssonline.org