Name *

Address *

Phone

Mobile *

Fax

E-Mail *

Full Time Enrollments (FTEs) *

Distance Education Enrollments *

Full Time *

Visiting *

Name *

Mobile *

:

Designation *

E-Mail *

:

Subject Specialization *

Phone *

Name

E-Mail

Phone

GSM

:

Immediately before the start of the Trial

Immediately after the start of the Trial

After 10-15 days from the date of Trial Activation.

None is Required.

Estimated Library Budget for Electronic Subscriptions/Archive Purchase

:

Current Subscribed Electronic Products(Databases/E-Books)

:

From Date *

:

To Date *

:

Institution IP Range/s

:

Remote Access Required

:

 YES

 NO

Institution's secured URL *

:

Preferred User ID & Password

: