Request to Register iEdison Organization
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) are required. Fill out the fields below and then choose "Submit" to submit your request.
Providing any federal funding agreement number that the Institution has received at anytime in the past will facilitate making a positive identification of the grantee/contractor Institution.
Grantee/Contractor Organization Name
*
Grantee/Contractor Organization Name
Organization DUNS
*
Organization Type
Select One
Individual
Large Business
Non-Profit Organization
Other
Small Business
If "Other," describe:
*
OTT Address
OTT Address Line 2
OTT Address Line 3
OTT Address Line 4
*
City
*
State
[Required if country is US]
Select One
AB
AK
AL
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
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MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
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NH
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NT
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OH
OK
ON
OR
PA
PQ
PR
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip
*
Country
Select One
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua/Barbuda
Argentina
Armenia
Aruba
Ashmor/Cartier
Australia
Austria
Azerhaijan
Bahamas
Bahrain
Bangladesh
Barbados
Bassas D India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia/Herzeg
Botswana
Bouvet Island
Brazil
British Iot
British Vi Iss
Brunei
Bulgaria
Burkina
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central Afr R
Chad
Chile
China
Christmas Is
Clipperton Is
Cocos (KEELNG)
Colombia
Comoros
Congo
Cook Islands
Coral Sea ISS
Costa Rica
Cote D'ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Rep
Ecuador
Egypt
El Salvador
Equator Guinea
Eritrea
Estonia
Ethiopia
Europa Island
European Patent Office
Falkland Iss
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynes
French So/Ant
Gabon
Gambia
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Iss
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard/Mcdon Is
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Iraq-Saudi Ara
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova I
Kazakhstan
Kenya
Kiribati
Korea Peo Rep
Korea Rep Of
Kuwait
Kyrgyzstan
Laos
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man Isle Of
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands An
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Is
Norway
Not Stated
Oman
Pakistan
Panama
Papua N Guinea
Paracel Iss
Paraguay
Peru
Philippines
Pitcairn Iss
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
San Marino
Sao Tome/Princ
Saudia Arabia
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovania
Solomon Iss
Somalia
South Africa
Spain
Spratley Iss
Sri Lanka
St Helena
St Kitts/Nevis
St Lucia
St Pierre/Miqu
St Vincent/Grn
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania U Rep
Thailand
Togo
Tokelau
Tonga
Trinidad/Toba
Tromelin Is
Tunisia
Turkey
Turkmenistan
Turks/Caicos I
Tuvalu
Uganda
Ukraine
United Arab Em
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis/Futuna
West Bank
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
*
OTT Phone
(999) 999-9999 ext.
OTT Fax
(999) 999-9999
*
Funding Agreement Number
*
Awarding Federal Agency
Note: "OTHER" is NOT a valid Awarding Federal Agency
AFRL/IF
AHRQ
ARMY/ARL
ARMY/ARO
ARMY/MRMC
ARMY/SMDC
ARMY/SSC
ATSDR
CDC
DHS/ST
DOC/EDA
DOC/ITA
DOD/DARPA
DOD/DMEA
DOD/DTRA
DOE
DOT
EPA
FDA
IHS
NAVY/ONR
NIH
NIST
NOAA
NRC
NSF
OTHER
USAF/AFOSR
USAF/ESC
USAID
USDA/ARS
USDA/FS
USDA/NIFA
Extramural Technology Transfer Administrator who will manage accounts for the
Organization
Prefix
(e.g. Dr., Ms., Rev.)
*
First Name
Middle Name
*
Last Name
Suffix
(e.g. Jr., Nobel)
*
Title
*
E-mail Address
*
Phone
(999) 999-9999 ext.
Fax
(999) 999-9999
*
Requested Username
(6 - 20 characters)
*
Requested Password
(6 - 20 characters)
Contact for Person on fax form
This section is for information about the signatory for the extramural organization.
If the signatory is the same as the Extramural Office of Technology Transfer Administrator,
check here and do not fill in the fields below.
Prefix
(e.g. Dr., Ms., Rev.)
*
First Name
Middle Name
*
Last Name
Suffix
(e.g. Jr., Nobel)
*
Title
*
E-mail Address
*
Phone
(999) 999-9999 ext.
Fax
(999) 999-9999
IEDISON-5000
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