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Name of the Company/Organization

Company Headquarters

Mailing Postal Address

Telephone No.

Fax No

E-mail

Web Page

Official Representative's Name

Telephone No.

E-mail

Head of Financial Department Name

Telephone No.

E-mail

Head of Legal Department Representative

Telephone No.

E-mail

Level of Membership Applying for

Patron (3,500 EUR)

Corporate (1,500 EUR)

Medium (750 EUR)

Small Business (500 EUR)

NGO (500 EUR)

Individual (250 EUR)

Main Activity of Your Company/Organization

Business Registration Number

Fiscal Number

VAT Number

Legal Form of Registered Company

Primary Business Sector:

Year of Registration:

Does your company/organization represent a U.S. based business? If yes, please specify

If your company is based in the United States, specify the city and the country:

State

Country

If your company is based in the United States and has a European headquarters, please list the European city and country:

State

Country

Does your company currently import U.S.‐manufactured products? If yes, please describe briefly.

Size of Company (number of employees); please specify:

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