Lusaka Chamber of Commerce And Industry
Membership Form
Name of Organisation
*
Certificate of Incorporation Number
*
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address
*
Street Address Line 2
Telephone
*
Format: (000) 000-0000.
Mobile
*
Format: (000) 000-0000.
FAX
*
Format: (000) 000-0000.
Mobile 2
Format: (000) 000-0000.
Email
*
Company Persons Contact
Name
*
First Name
Last Name
Designation
*
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Title
*
Please Select
Chief Executive Officer
Administrative assistant.
Administrative coordinator.
Secretary.
Receptionist.
Administrative manager.
Administrative director.
Administrative specialist.
Executive assistant.
Indicate Principal Goods & Services offered
Select Business Sector
Academic
Banking
Commercial Supply
Engineering
Manufacturing
Mining
Retail
Service
Other
Category
Corporate
International
Medium
SMEs
Membership Fees: Annually
CORPORATE: K5000. MEDIUM: K3000. SME: K2000. International Member: USD 1000. -------------------------------------------------------- BANK DETIALS Bank: Investrust A/C No : 0710198961018 Swot Code: 170005 Swift Code: VSTRZMLU -------------------------------------------------------- Airtel Mobile Account: 0972658665
Authorised Signature
*
Date
*
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Month
/
Day
Year
Date
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