Application for Associated Membership

Application for Associated Membership
Date of Application *

- Day - Month Year
Company Name *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Country code Phone Number
Sector *

Accounting Architecture/ Design Banking Construction Finance Food and beverages Governmental Health care ICT Industry/ Production Law Logistics and transport Marketing/ Communication/ PR Real estate Recruitment Research and development Retail Trade
Turnover
VAT Number
Website
Please indicate which Social Media platforms you and/or your company uses. *

Facebook LinkedIn Twitter YouTube None
Main Contact
Full Name *

Title First Name Last Name
Job Title *
Direct Line

- Country Code Phone Number
Email Address *
Please indicate your main language *

Dutch English French
Accounting Department
Email Address *
Membership Agreement
Associated Membership is for selected suppliers only who receive preferred supplier status, invitations to all events at discounted prices, our free electronic newsletter, free PR in our newsletter and social media channels and their logo on a dedicated page on our website.

Please note: Membership fees are for one year from date of invoice.
Please select your Membership. *

Company with fewer than 100 employees - 995 GBP + VAT Company with 100+ employees + 995 GBP + VAT
Please select the preferred type of payment *

Electronic bank transfer Credit card Direct Debit/ Domiciliëring/ Prélèvement Automatique
If Direct Debit, please select payment frequency.

One-off lump sum Quarterly Monthly
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Application for Associated Membership

Main Contact

Accounting Department

Membership Agreement