Proteker data request: contact form – Programme Proteker IPEV n°1044

Name *

Prénom

Nom

Agency / organisation / laboratory *

Adress

What is(are) your area(s) of interest ? *

What's your task ? *

E-mail address // Please enter a valid address (e.g. you@provider.com) *

E-mail

Confirmez l’e-mail

What data are requested? *

For what purpose do you request this information? (intented uses) *

Who will have access to the data? *

Will the data be disclosed to any third party? *

yes
no

If "yes", please provide details

Will data (or transformed data) be published?

yes
no

If "yes", please provide details

Do you have requested these data before?

yes
no

If "yes", please provide details

I acknowledge that I have read, understood, and agree to be bound by this data protocol in the event that my request is approved. I declare that the information I have given on this form is true and correct in all regards. Any data received will be used only for the purpose for which it was disclosed and will be accessed only by those authorised to use it. *

I do agree
I do not agree

I undertake not to disclose or publish the data (in any medium) without providing prior notification to PROTEKER. I acknowledge that a breach of this undertaking may result in the rejection of future requests for data submitted by me or by the agency/organisation/laboratory I represent. *

I do agree
I do not agree

Intellectual Property: The applicant agrees that the following statement be included in all publications (reports, articles, chapters, books, websites, etc.) where all or part of these data have been used. Data were kindly made available by the research project PROTEKER performed in the Kerguelen Islands (French Southern Lands) and supported by the French Polar Institute (IPEV, project n°1044) *

I do agree
I do not agree

Privacy notice: PROTEKER is collecting personal information on this form in order to process the data request detailed above. PROTEKER will not disclose this information unless consent is obtained or where the disclosure is required or authorised by or under law *

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