GIIF Project Renewal Form

GIIF Membership Renewal Form


Please complete and submit online, or print this form and post 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:
Organisation:
Membership Number:
Telephone:
Fax:
E-mail:
Date of Renewal:

Billing Information:
Company Purchase Ref:
Billing Address:(if changed)
Accounts Dept. Telephone:(if changed)

Methods of Payment:	Please choose 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.