Partner Program registration

Please use only ENGLISH characters. Fields marked with an asterisk * are required.


Organisation data
*	Organisation Name:
*	Industry/Field:
	Number of Employees:
	EU Funded Programmes Interested In:	FP7 CIP LLP LIFE+ Other, please specify:
	Community Programme Proposals Submitted in 2009:
	Community Programme Project started in 2009:
	Number of your colleagues participated at previous EM Trainings:
*	Address:
*	City:
*	Country:
	VAT number:

Personal data
*	Your Title
*	Your Firstname:
*	Your Surname:
	Your Position:
*	Your E-mail Address:
*	Your Phone Number:

Details of the contact person of the Europa Media Partner Program at your organisation
It is the same as above:
*	Title
*	Firstname:
*	Surname:
	Position:
*	E-mail Address:
*	Phone Number:

	Where did you hear about this partner program?:	Other, please specify:
I would like to subscribe for the Europa Media Newsletter published bi-monthly.
By registering, I agree to receive and further distribute internally bi-monthly notices about Europa Media's future trainings. I understand that the 5% discount is only valid if the Europa Media code is used during course applications.

	Comments:
	Security code:
		Change code
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