1. Applicant Information
Name of your organization/company
Location:
Street Address:
City/ county:
State/ province:
Zip code:
Country:
Website:
Contact person
First name:
Middle name:
Last name:
Title:
Email address:
Phone number:
Fax number:
Street address:
City/ county:
State/ province:
Zip code:
Country:
2. Describe the nature of the applicant's business activities.
For profit?
Not-for-profit?
Please indicate your preferences for joining GFSF Working Groups.
Industry Practices
Government Liaison/ Regulation
Technical/ Standard
Training
Membership
Trouble-shooting
3. If you were referred to GFSF, please fill out the following information.
Name of referring person:
Name of referring organization:
Email:
Phone number:
Otherwise, please indicate how you learned about GFSF: __________________________________________
4. Annual dues: |
Corporate membership: |
US $6,000 |
|
Government agency membership: |
discounted |
|
Method of Payment: ( Check the box for the payment method you prefer)
|
Wire Transfer |
|
By Check |
Please contact GIC Group for wire instructions.
Alex Lin
703-684-1366 |
Please send checks drawn on a US bank for US$ 6,000.00 made out to GIC Group to:
GIC Group
1434 Duke Street
Alexandria, VA USA 22314
|
To become a member, please fill out this application completely and submit it with your membership fee to GIC Group or mail to:
GLOBAL FOOD SAFETY FORUM
GIC GROUP
1434 DUKE STREET
ALEXANDRIA , VA 22314 USA
I would like to become a member of the Global Food Safety Forum (GFSF), and have filled out this application completely and accurately. I am submitting dues of $_______ along with my application and agree that this information will be held on my record for as long as I am a member.
Applicant Signature: ____________________________ Date: ___/___/_____
This membership fee is non-refundable and will be used toward GFSF activities and events.
|
