FAIB ... be international - in Belgium !

Please enclose with this completed form:

• the statutes
• a recent report of association activities
• financial report for the last financial year
• names of the current members of the Management Committee

Name of association:

Abbreviation:

Name and position of the person authorised to represent the association

Address

Telephone number

Fax Number

e-mail :

Website:

Objective(s) of the association:

I, the undersigned, representing

(Full name of the association)

hereby apply, on behalf of the association which I represent, for voting membership of the FAIB, to benefit from the rights and services for this category of members.

Date

Signature