ICMM Affiliate Membership Application form

ICMM Affiliate Membership Application form

For Non-Governmental Organisations, research institutes, governmental organisations and private companies involved in maritime heritage.
Name of your organisation in English: *
Name of your organisation in original language:
Please give a brief description of the business of your organisation: *
100 words max
Please give the reason your organisation would like to support ICMM: *
100 words max

Contact Details
Name of your Director: *

First Name Last Name
Director's job title: *
Director's email address: *
example@example.com
Would you like to subscribe to the monthly ICMM newsletter? *

Yes No
Name of primary contact at your organisation (if not the Director):

First Name Last Name
Primary contact's job title:
Primary contact's email address:
example@example.com
Would you like to subscribe to the monthly ICMM newsletter?

Yes No
Postal address of your organisation: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Website address of your organisation: *
General contact email for your organisation: *
example@example.com
Twitter account of your organisation (so we can follow you for news):
Facebook page of your organisation (so we can follow you for news):
Should be Empty:

Contact Details