Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth *Current Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry Email * Phone Number *Section DividerCurrent Occupation/Study *Educational Qualification (degrees, certifications..etc.) *Section DividerBrief Description of University: *Purpose of Affiliation: *Current Blockchain Programs/Courses of the University: *Future Plans in Blockchain Education/Research: *Section DividerResearch Collaboration Interests:Academic Exchange Programs *First ChoiceSecond ChoiceThird ChoiceJoint Events *ConferencesSeminarsWorkshopsStudent/Faculty Exchange Programs: *First ChoiceSecond ChoiceThird ChoiceSection DividerResources to Offer: *Support Needed from the Blockchain Center: *I, hereby acknowledge and affirm my commitment to comply with the policies and guidelines set forth by the Dubai Blockchain Center as a University Affiliate. By participating in or accessing any online services, activities, or resources affiliated with the Dubai Blockchain Center, I understand and agree to the following: Accurate Information: I certify that all information provided by me, whether during registration or engagement in online activities, is accurate, truthful, and complete. I understand that providing false or misleading information may lead to the suspension or termination of my affiliation with the Dubai Blockchain Center. Security and Confidentiality: I am responsible for maintaining the security and confidentiality of any login credentials, account information, and personal data associated with my affiliation. I will take appropriate measures to prevent unauthorized access to any sensitive information. Compliance with Policies: I agree to adhere to all applicable laws, regulations, and the policies and guidelines established by the Dubai Blockchain Center. This includes but is not limited to data protection and privacy policies, code of conduct, and any specific terms of service related to my affiliation. Usage of Information: I acknowledge that the Dubai Blockchain Center may collect and process personal information for the purpose of providing and improving its services. I consent to the use of my data in accordance with the organization's privacy policy. Ethical Conduct: As a University Affiliate, I commit to engaging in ethical and respectful behavior while participating in any online activities affiliated with the Dubai Blockchain Center. I will refrain from any activities that may be considered unlawful, harmful, or disruptive to the services or the experiences of other users. Intellectual Property Rights: I acknowledge and respect the intellectual property rights of the Dubai Blockchain Center and any third parties associated with the provided online services. I will not infringe upon these rights and will use materials and resources in compliance with relevant policies. Termination of Affiliation: The Dubai Blockchain Center reserves the right to terminate or restrict my affiliation without prior notice if I violate any terms or policies outlined herein. By continuing my affiliation or accessing online services, I affirm that I have read, understood, and agreed to abide by the terms and conditions set forth in this compliance statement. I acknowledge that this statement constitutes a legally binding agreement between myself and the Dubai Blockchain Center. *AgreeDisagreeThe Dubai Blockchain Center is committed to safeguarding the privacy of its University Affiliates. This Privacy Policy outlines how we collect, use, disclose, and protect personal information provided by University Affiliates in the course of their engagement with our services. 1. Information We Collect We may collect and process the following types of information from University Affiliates: Personal Information: This includes but is not limited to names, contact details, academic and professional information, and any other information voluntarily provided. Authentication Information: Login credentials and other authentication data for secure access to our online platforms. 2. How We Use Your Information We use the collected information for the following purposes: Affiliation Management: To manage and administer the affiliation between the University Affiliate and the Dubai Blockchain Center. Communication: To communicate important updates, events, and information related to the Dubai Blockchain Center and its activities. Improvement of Services: To enhance the quality and relevance of our services by analyzing usage patterns and feedback. 3. Data Sharing We do not sell, trade, or rent personal information of University Affiliates. We may share information with third parties only in the following circumstances: With Consent: When explicit consent is provided by the University Affiliate for specific data sharing. Service Providers: Engaging third-party service providers to assist in delivering and improving our services. 4. Security Measures We implement appropriate technical and organizational measures to protect the confidentiality, integrity, and availability of the information provided by University Affiliates. 5. Cookies and Analytics We may use cookies and similar technologies to enhance the user experience and gather analytics data. University Affiliates can manage cookie preferences through browser settings. 6. Your Rights University Affiliates have the right to access, correct, or delete their personal information. Requests related to these rights can be directed to [contact@email.com]. 7. Data Retention We retain personal information for the duration necessary to fulfill the purposes outlined in this Privacy Policy or as required by applicable laws. 8. Changes to the Privacy Policy We may update this Privacy Policy periodically. University Affiliates will be notified of any significant changes, and the latest version will be available on our website. 9. Contact Information For questions or concerns regarding this Privacy Policy, please contact us at [contact@email.com]. Thank you for being a valued University Affiliate of the Dubai Blockchain Center. *AgreeDisagree 1. **Personal Information:** - Full Name: - Contact Details (Email, Phone, Address): - Academic Information (Affiliated University, Department, etc.): - Professional Information (if applicable): 2. **Authentication Information:** - Login Credentials (Username, Password): 3. **Purpose of Data Collection:** - Affiliation Management: To manage and administer my affiliation with the Dubai Blockchain Center. - Communication: To receive updates, events, and information related to the Dubai Blockchain Center and its activities. - Improvement of Services: To enhance the quality and relevance of services through analysis of usage patterns and feedback. 4. **Data Sharing:** - I understand that my personal information will not be sold, traded, or rented to third parties. Any sharing of information will be done with third parties only in accordance with the Dubai Blockchain Center's Privacy Policy. 5. **Security Measures:** - I acknowledge that the Dubai Blockchain Center implements appropriate technical and organizational measures to protect the confidentiality, integrity, and availability of the information I provide. 6. **Cookies and Analytics:** - I am aware that cookies and similar technologies may be used for the enhancement of user experience and analytics. I can manage cookie preferences through my browser settings. 7. **Rights and Data Retention:** - I understand that I have the right to access, correct, or delete my personal information. Requests related to these rights can be directed to [contact@email.com]. The Dubai Blockchain Center will retain my personal information for the duration necessary to fulfill the purposes outlined in the Privacy Policy or as required by applicable laws. 8. **Changes to Privacy Policy:** - I acknowledge that the Dubai Blockchain Center may update its Privacy Policy periodically. I will be notified of any significant changes, and the latest version will be available on the organization's website. By submitting my personal information, I affirm that I have read, understood, and agreed to the terms and conditions outlined in this consent form. I voluntarily provide this information with the understanding that it will be handled in accordance with the Dubai Blockchain Center's Privacy Policy. *I, hereby grant consent to the Dubai Blockchain Center to collect, process, and store my personal information as a University Affiliate. I acknowledge that the information provided by me will be used for the purposes outlined in the Dubai Blockchain Center's Privacy Policy.By submitting the following information, I agree to the terms and conditions set forth in this consent form.Section DividerUpload Relevant Document(s) Click or drag a file to this area to upload. Section DividerI, hereby declare and confirm my understanding and acceptance of the terms and conditions outlined by the Dubai Blockchain Center for accessing and utilizing its online services, which include but are not limited to websites, applications, and associated platforms. By accessing and using the online services provided by the Dubai Blockchain Center, I acknowledge and agree to the following: 1. **Accurate Information:** I certify that all information provided by me during the registration or use of online services is accurate, complete, and up-to-date. I understand that providing false or misleading information may result in the suspension or termination of my access to these services. 2. **Security Responsibilities:** I am responsible for maintaining the confidentiality of my login credentials, account information, and any other personal data associated with my use of online services. I will take reasonable measures to prevent unauthorized access to my account. 3. **Compliance with Policies:** I agree to comply with all applicable laws, regulations, and the policies established by the Dubai Blockchain Center. This includes adherence to data protection and privacy policies, code of conduct, and any other terms of service specified by the organization. 4. **Usage of Personal Information:** I understand that the Dubai Blockchain Center may collect and process personal information for the purpose of providing and improving its services. I consent to the use of my data in accordance with the organization's privacy policy. 5. **Ethical Conduct:** I commit to engaging in ethical and respectful behavior while using the online services. I will refrain from activities that are unlawful, harmful, or disruptive to the services or other users' experiences. 6. **Intellectual Property Rights:** I acknowledge that all content, materials, and intellectual property presented through the online services are the property of the Dubai Blockchain Center or its licensors. I will respect and not infringe upon these rights. 7. **Termination of Services:** The Dubai Blockchain Center reserves the right to terminate or restrict my access to online services without prior notice if I violate any terms or policies outlined herein. By clicking "I Agree" or accessing the online services, I affirm that I have read, understood, and agreed to abide by the terms and conditions set forth in this declaration. I acknowledge that this declaration of authenticity and understanding constitutes a legally binding agreement between myself and the Dubai Blockchain Center. *AgreeDisagreeUpload Authorized Signature * Click or drag a file to this area to upload. Date / Time *DateTimeSection DividerSubmit