MEMBERSHIP – Eastern European Agricultural Alliance

Membership Statues *

Company Name: *

TAX ID Number: *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number in international format: *

Fax:

Email *

Website / URL

Information of the Person Completing the application form:

Name *

First

Last

Job title: *

Mobile Phone number in international format: *

Email *

Information of the Chief Officer:

Name *

First

Last

Mobile Phone number in international format (Chief Officer): *

E-mail address (Chief Officer): *

Information of the Financial Officer:

Name *

First

Last

Mobile Phone number in international format (Financial Officer)

E-mail address (Financial Officer) *

Indicate your industry *

If other, please specify: *

Products/Services Offered in Eastern Europe: *

Company is: *

If other, please specify: *

Please specify names of the ultimate beneficial owners and controlling shareholders: *

Number of Employees Worldwide: *

Please indicate the reasons your Company is interested in joining Eastern European Alliance *

Other reason for joining:

How many markets your company is planing to open with the help of Alliance in framework of your annual membership: *

1
2
3+

if number of targeted markets is more than 3 please indicate exact number: *

Indicate what targeted market/markets your company is going to open with the help of Alliance: *

COMMITTEES AND WORKING GROUPS ARE ALLIANCE DRIVERS OF POLICY-RELATED ISSUES AND THERE IS AN EXPECTATION BY THE BOARD OF DIRECTORS THAT ALL MEMBERS WILL PARTICIPATE ACTIVELY IN AT LEAST ONE COMMITTEE PROVIDING EXPERTISE AND SUPPORT.

Please chose Committee all issues you/your colleagues would be interested in participating in (at least one): *

Suggest an issue/problem that will initiate new committee *

We as an organization applying for Membership in the Eastern European Agricultural Alliance are familiar with and agree to abide by Alliance's Guiding Principles for a Business Code of Conduct.

*

Submission of participation in the Eastern European Agricultural Alliance marketplace and entering your personal data (as part of the registration procedure, by handing a business card or in another form) will be treated as confirmation of the Applicant's consent to include his personal data in the Eastern European Agricultural Alliance, in accordance with the Act of 29.08.1997 on the protection of personal data, Dz. U. No. 101, item 926 with changes and their collection, storage, changing and sharing by Eastern European Agricultural Alliance for communication, didactic and statistical purposes, including for the purpose of sending advertising and commercial information of Eastern European Agricultural Alliance electronically to the e-mail address provided in the application, as well as to provide and enable the speakers, sponsors or conference partners to contact the Reporter (for the purpose of presenting advertising and commercial information or cooperation proposals). The administrator of personal data within the meaning of the above The law will be Eastern European Agricultural Alliance based in Krakow (31-161) at ul. Szlak 8a. Under the rules provided for by the provisions of The Applicant's statute has the right to access your data, correct it and request to stop processing it. I agree to receive commercial information by electronic means from Eastern European Agricultural Alliance. I agree to share personal data for marketing purposes for entities cooperating with Eastern European Agricultural Alliance and to receive commercial information by e-mail from such entities.