APPLICATION FORM

Basic

Назва Компанії: *

Назва Компанії (назва компанiї укр. мовою): *

Сompany present in Ukraine sincе: *

Company logo (Please browse logo in format: *.jpg, *.jpeg, *.gif, *.png, *.bmp, Minimum size: W200 x H200 pixels)*:

Законний статус вашого Українського об'єкту: *

Сектор діяльності: *

Country of origin (headquarters and/or investment): *

Please mark if your company has representative office(s) in EU countries: *

YES

Company owner: *

Please mark if your company owner(s) is(are) citizen(s) of any EU country: *

YES

Please mark if the company involved employs less than 40 people world wide

Number of employees worldwide:

Число працівників в Україні: *

Office address

Building number: *

Name of the street, square, avenue, lane, boulevard: *

Business centre, office, apartment etc:

City:

Village:

District:

Область:

Country: *

ZIP: *

Cайт:

Адреса електронної пошти:

We agree that the mentioned e-mail address will be available for all visitors of the EBA web site

Telephone in Ukraine: * +380

Telephone in Ukraine: +380

Telephone Abroad:

Fax: +380

Please provide details of any trade associations of which your company is a member:

Please choose from the list below the EBA member companies whom you had/have cooperation/partnership with and who can recommend you as new EBA member: *

Профіль компанії (не більше ніж 500 слів): *

Contact person (i.e. the main contact with EBA for membership administration)

First Name: *

Last Name: *

Адреса e-mail: *

Position: *

Person who fills in the application form

First Name: *

Last Name: *

Адреса e-mail: *

Position: *

Head of Company (Director, Head of Representative office, Country Manager)

First Name (eng): *

Last Name (eng): *

First Name (ukr): *

Last Name (ukr): *

Salutation: *

Position: *

Адреса e-mail: *

Birthday: *

E-mail adress will only be included into CEOs mailing list for special EBA TOP Card holder event invitations

Perception and expectation

What do you know about the EBA?: *

What outcome do you expect to have from your EBA membership?: *

Type of EBA membership

Type of EBA membership:

Full

Associate

Full (companies originated from EU countries or owned by EU citizens and/or being present in EU countries)
Associate (companies originated from non-EU countries and not being present in EU countries)

We are interested to participate in the activities of the EBA Regional Branches

Брюссель: