GIIF - Global ISDN Industry Forum

GIIF Membership Application Form

Please complete and submit online, or print this form and return to: GIIF Secretariat WesternConnect Ltd. 25d Bishop Street, Derry, N. Ireland, BT48 6PR Tel: +44 1504 379111 Fax: +44 1504 379112 Email:stellal@westernconnect.com The membership fee per organisation is US$5,500 (or the Sterling equivalent) VAT at 17.5% is applicable to UK-registered companies
Signifies Required Data
Contact Details:
First Name(s):
Surname:
Company Name:
Company Type:
Position in Company:
Department:
Company Address:
Telephone:
Fax:
E-mail:
Other E-mail Recipients:


Billing Information:
Company Purchase Ref:
Billing Address:
Accounts Dept. Telephone:
Methods of Payment:	Please select one of the following methods
	1. Cheque ...............
	2. Bank Transfer ...
	3. Credit Card ........

1. Cheque: I will forward a cheque made payable to:	GIIF Secretariat WesternConnect Ltd. 25d Bishop Street, Derry, N. Ireland, BT48 6PR.

2. Bank Transfer:
Ulster Bank, Knock Branch, Belfast, Northern Ireland. Sort Code 98-01-30. Account Number 19432273. Note. Please route through National Westminster Bank, London

3. Credit Card: Please debit my:
VISA AMEX ACCESS MASTERCARD
Card Number:	Expiry Date:
Signature:_______________________________

Please indicate if you wish your details to be published in the Members Database. Access to the Members Database is limited to GIIF Members only. YES, I wish to have my contact details published in the Members Database. NO, I DO NOT wish to have my contact details published in the Members Database.