Application for Membership:

Date of Application: Day Month Year

Company Name: Turnover:
VAT Number:

Business Activity:
(give 10 key words describing your business for our search engine)

Title: *Other
Family Name: First Name:

Job Title:

Address: City:
Post Code: Country:

Telephone Details: (With Dial Codes)

Office Number: Direct Line:
Mobile Number: Skype Number:

Fax Number:

E-Mail Address: Website Address:

Human Resource Manager:

Title: *Other
Family Name: First Name:
Telephone Number: E-Mail:

Press Office:

Title: *Other
Family Name: First Name:
Telephone Number: E-Mail:

Accounting Department:

Title: *Other
Family Name: First Name:
Telephone Number: E-Mail:

Your first language (Mother Tongue): *Other

Membership Fees From today to 31st December 2012

Please indicate which category your company belongs in.

Companies with LESS then 100 employees
Fee: €390

Companies with MORE then 100+ employees
Fee: €725

Patron Member
Fee: €2500

Payment Method:

Our remittance in EURO's from the period to 31.12.2012 has been transferred to the Chamber's account at KBC Bank London.

IBAN: GB63 KRED 1610 5960 7067 91 BIC KBC UK: KREDGB2X

If you have any comments or questions please submit them in the space below:

The Belgian-Luxembourg Chamber of Commerce in Great-Britain
Westwood House, Annie Med Lane, South Cave, East Yorkshire, HU15 2HG, United Kingdom
+44 (0)207 127 4292 / fax +44 (0)870 429 2148 / info@blcc.co.uk / www.blcc.co.uk