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To: Asia-Pacific Advanced Network
(APAN)
APAN MEMBERSHIP APPLICATION
FORM
Name of Organization: ______________________________________________________
URL : ______________________________________________________
Type of membership applied for:
(a) Primary Member
(b) Associate Member
(c) Affiliate Member
(d) Liaison Member
(e) Industry Member
Please provide billing contact:
Name: ______________________________
Organization Name (if different from
applicant):
______________________________________________________________________
Address:
______________________________________________________________________
______________________________________________________________________
E-mail: ______________@ _____________
Phone:+ _____________________________
Fax:+_________________________
Description of your organization:
Description of your organization's interest in
APAN:
Applicant:
Name: _____________________________
Designation: ________________________
Date: _________/_________,
2004
Please fill this form and send to info@apan.net
Thank you very much for joining
APAN | 