Brekeke SIP Server

Academic Ed. License Request Form

* Required fields
First Name *
Please enter first name
Last Name *
Please enter last name
Email Address *
Please enter a valid email address
Please make sure to enter your email address given by the academic institution here. We do not issue an Academic License to a web-mail address (i.e., yahoo, gmail, hotmail, etc.)
If you are not qualified for an Academic License, please use our free 60-Day Trial License.
School Name *
Please enter school name
Your Title *

(i.e., Student, Professor)
Please enter your title
School Website *
Please enter website URL
Country
  Other: 

Where did you hear about us?
Please provide the details about intended usage at your academic institution.*
This field is required in order for you to submit this form.

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