Organisation Membership Application Form

    Organisation Name

    Street Address

    ZipCode         City        Country

Delegate

    Title (e.g. Dr., Mr., Ms., etc.)
    First Name
    Last Name
    Function in the Organisation (e.g. CEO, Secretary, Director, etc.)

    Telephone
    Cellular Telephone
    Telefax
    Email1
    Email2

I apply for membership in name of the organisation above. The 2003 membership fee amounts 400€.