ICERM Academic Sponsorship Commitment Form
After successful completion of the form, you will receive a response within 1 to 2 business days with additional information about your sponsorship and an invoice.  

Kathryn Boots can answer any questions you may have.  She can be reached at (401) 863-5018 or kathryn_boots@icerm.brown.edu.
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Check appropriate level: *
Required
Start Date: *
The standard sponsorship dates are September 1st through August 31st.  If you are joining for the current year after September then we will prorate your membership cost.
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Name of Institution/Academic Department: *
Contact Name: *
This person will be contacted before any funds are spent and will be added to the ICERM listserv.
Contact Mailing Address: *
Contact Phone Number: *
Contact Email Address: *
Departmental Website: *
To be used as a link on the ICERM Academic Sponsor website.
Name of your department as it should appear in ICERM marketing materials and online: *
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