ProConsort Membership Request

Thanks for your interest in applying for ProConsort membership. Everyone here at ProConsort is committed to making your membership experience a rewarding one. As a first step, it’s important that we validate your institution's identity and eligibility for membership. To get started, please complete and submit the Membership Application request provided below. We'll review your request and get back to you with a full application form as soon as possible.

Institution Name

Institution Website

Institution Address

Country

Street address

City

State

Zip code

Institutions assign administrative responsibilities differently based on the size and mission of the Institution. To accommodate these differences among our members, the ProConsort Contract Request form defines three distinct tasks that can be assigned either to the same person or to separate persons in your organization. These tasks are:

Task 1 - Complete and Submit Contract Request

Title

First Name

Last Name

Task 2 - Complete Contract Application (Please designate person responsible below)

This person will also submit the completed contract for official approval. When your application request is approved the designee will receive a contract application form. The designee will be asked to complete the contract application and obtain an authorized signature on the actual contract document.

I will complete Contract Application

Designate responsible person

Contract Applicant's Title

Contract Applicant's First Name

Contract Applicant's Last Name

Contract Applicant's Email

Task 3 - Act as Account Administrator (Please designate person responsible below)

This person is authorized to place orders and to manage the roles of any other staff assigned to the account.

I will act as Account Administrator

Contract Applicant will act as Account Administrator

Designate responsible person

Account Administrator's Title

Account Administrator's First Name

Account Administrator's Last Name

Account Administrator's Email

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