Membership Application Form

ORGANIZATION
NAME OF ORGANIZATION*
Please enter the name of organization to be registered: *
REGISTRATION NUMBER (RC)*
Please note that all NILOBF Applicants MUST be incorporated with the Companies House to qualify-except professional individuals:
YEAR ESTABLISHED
State year of incorporation with the Companies House
Year of incorporation:
Total employees as at today:
Total employees as at last year:
BUSINESS ADDRESS
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Company Email:*
Description of business (products, services etc)
Business sector (please provide sic code if known)
Parent/holding company (please state if applicable)
Were introduced by a friend or member of NILOBF?*
- Yes
- No
Member company name
Name of friend
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact name
First Last
Job Title
Please complete the following

PRINCIPAL CONTACT
Provide the name of person who should be contacted for NILOBF Membership Administration
Prefix
Name
First Last
Title:
Position in office:
Phone/Cell:
Email
ALTERNATIVE CONTACT:
Please provide information on Alternative Contact in the event Principal Contact is unavailable.
Prefix:
Name
First Last
Title:
Position in office:
Phone/Cell:
Email
Please state contact details of your Secretary or PA
Title:
Name
First Last
Job title:
Responsible for:
Telephone:
Fax:
Email
Please state here name of the person to contact in your Finance Department
Title:
Name
First Last
Job title:
Responsible for:
Telephone:
Fax:
Email
Please state here name of the person to contact in your Marketing Department
Title:
Name
First Last
Job title:
Responsible for:
Telephone:
Fax:
Email
Please state here name of the person to contact in your HR Department
Title:
Name
First Last
Job title:
Responsible for:
Fax:
Email

ORGANIZATION