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Membership application

Please fill in the form carefully. We will send you an invoice according to the membership category you choose. Having paid the invoice, you will become eligible for all membership benefits.

Membership type *

	Patron membership (75,000 CZK)
	Corporate membership (25,000 CZK)
	Personal membership (8,000 CZK)
	NGO membership (8,000 CZK)

Company

Company name / Name : *

Legal form: *

Invoicing address: *

Delivery address, if different:

Id No. (ICO): *

VAT Id No. (DIC): *

Website: *

Company activity: *

Facebook:

LinkedIn:

Mother company, country:

Contact person

Name: *

E-mail: *

Phone: *

Mobile:

Position in company:

CEO / Director

Name: *

Phone:

E-mail:

Fields marked with asterisk (*) are mandatory.

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