Application form

ABOUT YOUR ORGANISATION (1/2)
Organisation Name (the name that you want us to use on our online directory)*
Legal Name (if different from the one indicated above)
Corporate Parent Organisation (if applicable):
Type of organisation:*
Could you specify?*
Headquarters Location*

Street Address

Street Address Line 2

CityCountry

Postal / Zip CodeCountry
Organisation Phone Number

PrefixPhone number
General Email:
Describe your main activities, mission & vision (this information will allow us to create your public member profile on our website)*
(250 words maximum)
Website:*
Linkedin Profile:
Twitter Profile:
Please upload a high-resolution logo of your organisation:*

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CONTACT PERSONS
Main Contact (the main contact person will receive all communications from EVPA, such as invitations to member-only events)*

SalutationFirst NameLast Name
Position / Title
Email:*
example@example.com
Phone Number

PrefixPhone number
Billing Contact:*

SalutationFirst nameLast name
Position / Title
Email:*
Phone Number

PrefixPhone number
Are the billing company name and address the same as the ones mentioned above?*

YESNO
Billing Company Name:
Billing Company Address:

Address

Address (Line 2)

CityCountry

ZIP/Postal Code
Intracommunity VAT Number (if not applicable indicate this with N/A):

You are eligible for a reduced fee if your average annual operations expenditure is below 300K€. If you would like to apply for the reduced fee, indicate the average annual operations expenditure over the last years. (We define operating costs as the cost associated with the maintenance and administration of the organisation on a day-to-day and administration of the organisation on a day-to-day basis). Write N/A if you aren't eligible. Are you eligible for the reduced fee?*

YesNo
Please upload here some documentation that shows your Average Annual Operational Expenditure is below 300K€. *

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ADDITIONAL CONTACTS
Being part of our network means involving you and your team in research, articles, interviews, helping provide visibility to your work.

2.12.0.0
Would you like to nominate other persons of your organisation for research, communication, or policy purposes?*

YESNO
RESEARCH Contact:

SalutationFirst NameLast Name
Title / Position:
Email:
COMMUNICATION Contact:

SalutationFirst NameLast Name
Title / Position:
Email:
POLICY Contact:

SalutationFirst NameLast Name
Position / Title:
Email:

EVPA ASSOCIATE MEMBER