QUP Membership Application

Before completing this application, please review the QualNet University Program requirements.

Also make sure you have an account for the QualNet Community Forums (online message board). To join QUP, you must register for the General QualNet Forum with a valid University-provided email address.

Enter your information: (* denotes required field)

Personal Information First Name * Last Name * Title Email Address * Phone Number * Organization * WebSite URL Address Department Address 1 * Address 2 City * State/Province * Zip/Postal Code * Country --- Select United States Afganistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos Island Columbia Comoros Congo Cook Islands Costa Rica Cote DIvoire Croatia Cuba Curaco Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherland Antilles Netherlands Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Island Palestine Panama Papua New Guinea Paraguay Peru Phillipines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda St Barthelemy St Eustatius St Helena St Kitts-Nevis St Lucia St Maarten St Pierre & Miquelon St Vincent & Grenadines Saipan Samoa Samoa American San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Serbia & Montenegro Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda Ukraine United Arab Erimates United Kingdom Uraguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana Is Yemen Zaire Zambia Zimbabwe * Fax Number Survey Faculty Advisor First Name * Faculty Advisor Last Name * Faculty Advisor Title Advisor Email * License server OS and version * This is the IP address of the server machine on which the license server will reside. License server IP address ? * (If the license server is Windows or Linux, please submit the MAC address of the license server. If the license server is Solaris, please submit the output of /usr/bin/hostid.) License server hostid ? * Permitted values: 0-255 or an asterix (*); all IP addresses must be owned by your university License IP address range 1 ? * Permitted values: 0-255 or an asterix (*); all IP addresses must be owned by your university License IP address range 2 ? Permitted values: 0-255 or an asterix (*); all IP addresses must be owned by your university License IP address range 3 ? 1. What is your main area of teaching and/or research and how do you plan to use QualNet? * 2. What papers related to your area of research and/or QualNet have you or your colleagues published? (Please list the location of them online or where to request a copy.) 3. Include any additional information or requests: 4. Which conferences do you or members of your research group plan to attend in the next year? If you plan to present QualNet research at any conferences, include specifics on the conference and paper topic. Please use the area below for submitting your research summary (or you may include a 1-page typed WORD document with the QUP Membership Application you will send via fax, and email the WORD document file to us). An example of research summaries by current QUP members is available at http://www.scalable-networks.com/customers/qup/member_profiles.php If you submit here, there is a 800 character minimum and 2000 maximum. By checking this box, I understand that SNT may reject any incomplete or redundant download request and I declare this information to be as accurate as possible.* Please note that it may take up to 48 hours to complete your request.