COMPANY MEMBERSHIP APPLICATION

Part 1: Personal Details

Please note: Fields marked with a * must be completed

Company :		*

Address 1 :		*
Address 2 :
Town/City :		*
County/ State :		*
Country :		*
Zip/ PostCode :		*

Date Of Birth :
Email Address :		*
Telephone :
QA Manager :

Part 2: Terms & Conditions

1. I confirm (to the best of my knowledge and belief) that the above information is accurate as at the date hereof.

2. I understand that upon receipt of this Application you will forward an e-mail to me which will contain my unique Payment Reference Number which I must quote when I submit my Membership Fee to the Association either by way of Direct Wire Transfer or International Money Order or Cheque.

3. I confirm that I will submit my Membership Fee (currently £250.00 GBP) to the Association when I have received my Payment Reference Numbner and (subject to the acceptance by the Association of my Application) I hereby authorise
the Association to submit the HARDCOPY of my Membership Cetificate to my above address.

4. I also authorise the Association to publish my above e-mail address and (if applicable) my above web site URL in my ONLINE Membership Certificate.

Part 3: Preview Your Application

Click Preview button to preview your Application data that you are sending to us