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Membership Registration Form

Fields marked with an * are mandatory!

Name of company *
Address Line 1* (P.O. Box numbers not accepted)
Address Line 2
City *
County / Province / State *
Post code *
Country *
Telephone *
Fax *
e-mail address *
Website

Company Registration Number
Established *
Turnover in GBP *
Number of employees *
Subsidiaries
Parent Company
SIC Industrial Code
ISO 9000 Accreditation
Other accreditations
Memberships of trade associations and chambers. Please include URL, and address, if possible.

Type of business *	Manufacturer Distributor
	Agent Consultant
Other
Type of company *	Public company Private company
	Partnership Sole Trader
Other


Your main products / services *
Product 1
Product 2
Product 3
Product 4

Please describe your business interests with us:
*) We reserve the right to amend or shorten the information provided.

Where did you hear about us? *


Membership Fee
Size of Business:
Companies with:
Less than 15 employees
Between 15 and 75 employees
More than 75 employees

	Please invoice my company


All Fees have to be paid in advance.
		Order Nº.

Registration form completed by:		Date:
First Name *
Surname *
Job Title *
VAT Number * ( if not registered, insert N/A )
Telephone *
e-mail address * (company e-mail; please no Web e-mails)
Signature

1. Please print off this form (Click File on the main menu of your browser followed by Print)

2. Click the "Submit" button.

3. Fax a signed copy to + 44 23 9251 3746.

You confirm that you are authorised to act on behalf of your company and that you have read and accepted the Terms of Use.