APPLICANT INFORMATION APPLICANT INFORMATION

Organisation Legal Name

Organisation Short Name

Registered office address

Country

Website

Describe briefly how will your organisation be able to contribute to EMIRI’s goals

MAIN CONTACT PERSON MAIN CONTACT PERSON

Title TitleDr.Mr.Ms.Mrs.Prof.

First name

Last name

Job Title

Phone number

E-mail address

MEMBERSHIP TYPE MEMBERSHIP TYPE

Select type Select typeIndustrialResearchAssociation

Select Size Select Size +5000 employees 9680 Euros 1000 – 4999 employees 7260 Euros 250 – 999 employees 4840 Euros -250 employees 3025 Euros

Select Size Select Size +5000 employees 12100 Euros 1000 – 4999 employees 8470 Euros 250 – 999 employees 6050 Euros -250 employees 3630 Euros

Trade associations, technology platforms, NGOs and other stakeholders – 0€ Trade associations, technology platforms, NGOs and other stakeholders – 0€

BILLING INFORMATION BILLING INFORMATION

VAT registration number

First name person for FINANCE

Last name person for FINANCE

E-mail address for FINANCE

I acknowledge having read the read the statutes of the Association (EMIRI) I acknowledge having read the read the statutes of the Association (EMIRI) Yes

I agree to be legally bound by the statutes of the Association (EMIRI) once the applicant organisation has become a member of EMIRI I agree to be legally bound by the statutes of the Association (EMIRI) once the applicant organisation has become a member of EMIRI Yes