Application for EBA Membership

Basic Information
Name (Organisation/Company)*
Invoicing name
Address*

Street Address

Street Address Line 2

City

Postal / Zip CodeCountry
Website
Company domain name
Main contact*

First NameLast Name
Invoicing Main Contact
Position*
Email*
example@example.com
Invoicing contact to email
Phone Number (Mobile)

Area CodePhone Number
Phone Number (Office)

Area CodePhone Number
Marketing contact

First NameLast Name
Marketing Contact Email
example@example.com
Contact for Policy Related Matters

First NameLast Name
Email for Policy Related Matters
example@example.com
Contact for invoicing*

First NameLast Name
Invoicing contact CC
Email for Invoicing*
example@example.com
Invoicing contact CC emails
VAT number*
Specials for invoicing
Do not hesitate to send us more contacts to include in our database after approval of your application.

The contacts will be visible in the networking directory available for EBA members only. Please inform us if you do not wish to have your contact details displayed. They will be still used for the management of your membership.

Consents and signature
Consents*

I agree with the EBA statutes and the membership fee regulation.I have read and understood EBA’s Privacy Policy and Terms and Conditions.I hereby certify that the information I have provided in this application is correct.I hereby confirm that I have the authority to apply for EBA membership on behalf of my organisation.
Please review the EBA statutes, EBA's Privacy Policy and Terms and Conditions.
Date*

MonthDayYear
Name of the authorised representative*

First NameLast Name
Position*
Should be Empty:

Membership category