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Visiting Scholar Directory Information Form


Directions: Please complete and submit this form if you wish to be listed in the Visiting Scholar Directory.

New Submission   Updated Information


First Name
Last Name

Home Institution

Home Institution Position

Host Institution

Host Institution Position

Host Institution Location:

    City: State:

    Country (if not U.S.):

Area(s) of Specialization:
You may select up to three areas below.





Dates at Host Institution:
to

Date Returning to Home Institution

Contact Information
Please indicate how you can be reached during your visiting appointment. If you would like any of this contact information posted in the Visiting Scholar Directory on the AJS website, please select "Yes" to the left of the field; otherwise, the information will be for AJS office use only.

Post on AJS website?
 
Yes
No
 


E-mail


Mailing Address - Line 1

Mailing Address - Line 2

Mailing Address - Line 3

City

State/Province

Zip/Postal Code

Country

Telephone (Office)
Telephone (Home)
Telephone (Mobile)
Fax