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Membership Application World Communication Forum Association (WCFA) Non-profit Organization

Please, complete the form with all due information, print it, and return signed as a scan via email. For further information or queries, please email us at: forum@forumdavos.com

Personal information Title*:

Mr.;

Mrs.;

Ms;

Dr.;

Other:

Sex: Male; Female First and last (family) name*: Organization, position held*: Postal address, city, code, country*: Phone* (global code - city area - number): Mobile* (global code - city area - number): Email*: Contact person (if different from the applicant): Position, phone, email:

Additional data

Projects you are proud of*: Professional awards: Professional mission*: Tw/Li/FB accounts: Blogs:

Annual Fee

type “x” in the appropriate box

One-time Entry Fee**

Amount* 200 euro

for new members only

Annual Membership Fee**

200 euro

TOTAL**:

200 euro

NB! The above fees refer to annual membership in WCFA from date of application until end of December 2015.

I apply for WCFA membership and agree to abide by the Code of Conduct. I confirm that all details provided here are complete and correct and that I have read and accept the valid statutes and regulations of the World Communication Forum Association. I agree the data submitted by me to be processed for purposes pursued by the Association. Invoices: only for Bank Transfer payments! (Ask for bank details: forum@forumdavos.com) For due bank transfer as per Pro-Form Invoice issued upon receipt of this application (paper invoice is due upon payment), I’d like the WFCA organization to invoice the*: Company; Person, namely: I hereby agree to pay the due total amount of*: 200 Euro, in words - two hundred Euro Date of application*: *Obligatory Information ** NB! > One-time Entry fee is NOT due for 2015! > Annual fee is Preferential for 2015!

Applicant’s signature: __________________________


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