Membership Form

Name of organization: *

Address of organization: *

VAT-number in native country: *

Name of contact person: *

Address contact person:

E-mail contact person: *

Phone contact person:

Do you have any comments?

I, the undersigned, hereby apply for:

Founding Membership (Fou)Institutional Membership (Inst)Affiliate Membership (AFF)

I declare that I have read and understood the statutes of ScanBalt including rules for cancelation of a membership