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Name of the Company/Organization

Company Headquarters

Mailing Postal Address

Telephone No.

Fax No

E-mail

Web Page

Applicant's Name

Telephone No.

E-mail

Official Representative's Name

Head of Financial Department Name

Head of Legal Department Representative

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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