P O L I T E C H I N S T I T U T E

Tuesday, 7 September 2010

membership application form

Please read our Membership Overview and Rates (PDF, 104k) before completing the Membership Application Form.

Once you have submitted your completed application we will send you an invoice by email for payment of membership fees. In order for us to process your application correctly, we may need to contact you to verify some of the information. Application will become effective upon receipt of fee payment.

Please complete the form below to apply for POLITECH Institute membership:

[*] mandatory fields

your details

[*]Title:
[*]First Name:
[*]Last Name:
[*]Membership:
Organisation/Company: (if applicable)
[*]Postal Address:
[*]Postal Code:
[*]City:
[*]Country:
[*]Phone:	(Please include [+] and the international dialing code)
[*]Email:
Website:
	[*] I have read POLITECH INSTITUTE's Membership overview and rates and I acknowledge that membership application will become effective upon receipt of fee payment