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Corporate Membership Registration Form


The undersigned organisation wishes to become a Corporate BELTUG member

Company information

(all fields indicated with an * are mandatory)
 



Your Order Nr to facilitatie payment procedures (enter N.A. if not applicable) *: 
How I got to know BELTUG (via?) *: 

Member 1:


Title :     

Last & First Name : 
Function title : 
E-mail : 

Language :       

Function category : 

If other, please specify : 

Member 2:


Title :     

Last & First Name : 
Function title : 
E-mail : 

Language :       

Function category : 

If other, please specify : 

Member 3:


Title :     

Last & First Name : 
Function title : 
E-mail : 

Language :       

Function category : 

If other, please specify : 

Member 4:


Title :     

Last & First Name : 
Function title : 
E-mail : 

Language :       

Function category : 

If other, please specify : 

Remarks:


Please specify : 
 

I wish to adhere to BELTUG vzw/asbl. Our membership will be valid until January 1st 2013:

Corporate Membership (4 people of your company can enjoy full advantages of membership ) : € 675 (ex VAT)

Click "submit" to transmit your affiliation per e-mail or send to:

BELTUG vzw/asbl
Attn Ms A. De Ridder / Knaptandstr 123 at 9100 Sint Niklaas (Fax 03/7664186).
A written confirmation and an invoice will be send to you upon receipt of this form.

Thank you for registering.

 
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