WPS Coalition Membership Form Question Title * 1. Your contact information: Name Country Email Address Phone Number Question Title * 2. Your professional sector: Academic Undergraduate Postgraduate Government Defence Forces Non-government Private Other Question Title * 3. Your organisation/network/institution (optional) Question Title * 4. Are you based in Australia? Yes No (please specify) Question Title * 5. Are you joining the Coalition in individual capacity or as representative from your organisation/network? Individual Organisation/Network Next