Please print the form below, fill it out, sign it, and fax it to +48 22 566 96 42
REGISTRATION FORM - FORMULARZ ZGŁOSZENIOWY 2008 Belgian Business Chamber
| Company / Przedsiębiorstwo: | ............................................................................................. | ||
| Slogan: | ............................................................................................. | ||
| Street/Ulica: | ............................................................................................. | ||
| Code/Kod: | ...................................................... | City / Miasto: | ...................................................... |
| Tel: | ...................................................... | Fax: | ...................................................... |
| Mobile: | ...................................................... | ...................................................... | |
| Website: | ...................................................... | Sector: | ...................................................... |
| Nbr. Empl: | ...................................................... | VAT / NIP: | ...................................................... |
| Mother Comany | ...................................................... | Existing in Poland since | ...................................................... |
| Link with Belgium | ............................................................................................. | ||
| Link with Poland | ............................................................................................. | ||
| Name: | ............................................. | Position: | ............................................. | e-mail: | ............................................. |
| Name: | ............................................. | Position: | ............................................. | e-mail: | ............................................. |
| Name: | ............................................. | Position: | ............................................. | e-mail: | ............................................. |
You engage your company or yourself to pay the membership fee of:
Państwa lub państwa firma zobowiązują się przelać składkę członkowską w wysokość:[ ] 9'950 PLN - Gold sponsor: advantages: on the BBC website (last year 48'250 page loads from 15'702 unique visitors!) your logo always on top + your logo in ALL formal communications of the BBC + your logo on banner during ALL our anchor events + unlimited number of articles on our website + a full page article in the newsletter (almost 2000 addressees!) + all below
[ ] 4'950 PLN - Silver sponsor: advantages: on the BBC website (last year 48'250 page loads from 15'702 unique visitors!) your logo with link to your company + a special reference in the Catalogue 2008+ one half page article in the newsletter (almost 2000 addressees!) + article on our website + all below
[ ] 1'650 PLN - membership for companies: advantages: on the BBC website, link to your website with basic information + the company can be represented by 3 persons at any free event + all below
[ ] 440 PLN - membership for individuals and small companies (max 2 employees), voting rights at the annual meeting of the members; free basic registration in the Catalogue 2008 (companies only).
[ ] Please tick the this box if the membership ordered above is an UPGRADE, we will contact you then in order to agree on the exact amount to pay.
[ ] Please tick if you would like to discuss about having your publicity on our website
To/Na Belgian Business Chamber - Fortis Bank Polska S.A. - 63 1600 1127 0003 0122 8419 0001
[ ] We would like to be present in the BBC Catalogue 2008 / Jesteśmy zainteresowani zamieszczeniem informacji w BBC Catalogue 2008:
[ ] We would like to sponsor the monthly cocktail of BBC / Jesteśmy zainteresowani sponsorowaniem koktajli BBC : (We will contact you in order to discuss the possibile dates, however all dates in 2007 are already reserved, as well as January, February, November and December in 2009!)
Zgodnie z ustawą z dnia 28 sierpnia 1997 o ochronie danych osobowych (Dz.U. 1997, Nr 133, poz. 883,) wyrażamy niniejszym zgodę na przetwarzanie naszych danych w ramach listy firm będących członkami Belgian Business Chamber i ich udostępnianie zainteresowanym osobom.
Referring to the polish law of August 28 1997 on the protection of personal data ((Dz.U. 1997, Nr 133, poz. 883,) we hereby give our consent to process the
above mentioned information in the framework of the Belgian Business Chamber member companies list and to distribute it to any interested third parties.
Date / data : ................................. Signature / Podpis : .....................................................
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