Sponsor Membership Application Form

    Membership #
    Email of the Delegate of the Member

Contact person for the Sponsorship

    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 of the Contact person for the Sponsorship
    Email2 of the Contact person for the Sponsorship

Details of the Sponsorship

I apply for the sponsorship of the PITCH Prize (20,000€ per annum)

I apply for sponsorship (5,000€ per annum)

I apply for the sponsorship of a PITCH Event (€)

• Event:   

• Specific purpose of the sponsorship, if any: