Application for Associated ACWUA Membership (NGOs and Academic Institutions)

Fields marked with a red asterisk are mandatory!

Nominated Representative

Title*

Mr.

Mrs.

Academic title/Degree

First name*

Last name*

Position

Department

Please send me documentation from ACWUA for information purposes.

Yes

No

Company Data

Company/Authority/Community/Organisation*

Company line 2

Address*

Address line 2

Address line 3

Address line 4

Address line 5

P.O. box

ZIP

City*

Country

Contact Data

Phone*

Phone 2

Phone 3

Fax

E-mail*

E-mail 2

Internet