European Federation of Corrugated Board Manufacturers Application Form for FEFCO Corresponding Membership Please complete, sign and return this form to Houriet Lefebvre at houriet.lefebvre@fefco.org ________________________________________________________________________ Company …………………………………………………………………………………………………. Brand ………………………………………………………………………………………….……………. Activities ..………………..…………………………………………………………………………..……... Address …………………………………………………………………………………………………… City ……………………… Zip code: …………………… Country …………….……………………… General Phone ………………………………………..… General Fax ………………..….…………. General e-mail ………………………………………… Website …………………………...……… VAT Number ……………………………………………………………………………………………….. Contact Person Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. CEO/General Manager: Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Technical Manager Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Marketing Manager: Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Sales Manager: Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Other staff Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Please specify below to whom we send information about FEFCO activities & events Name & Surname ……………………………………………Title/Gender: .………………………………. Function …………………………………………………… E-mail ..…….……………………………… Direct Phone: ……………………………………………… Mobile….………………..…………………. Please feel free to add as many positions as required We confirm that as of today we wish to become a Corresponding Member of the European Federation of Corrugated Board Manufacturers, located at 250 Avenue Louise, 1050 Brussels, Belgium; and with the understanding that we will be asked to pay an annual membership fee of 3.000,00€. Date: ……………………. Signature: …………………………………