Membership Adherence Form - Infrachain

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Membership Adherence Form

* Required

Company *

Country *

City *

Postal Code *

Street *

Company phone *

Company Registry Number *

Describe your company's involvement and interest in Blockchain and Infrachain *

Main Person of Contact *

Phone *

Email Address *

Type of Membership and Membership Fee (Invoiced yearly at adherence date): Revenue from EUR 0 to 1,500,000 -> EUR 1,000Revenue from EUR 1.500.001 to 15.000.000 -> EUR 4,000Revenue from EUR 15.000.001 and more -> EUR 6,000

Copy of company/organization by-laws *

Latest financial statement *

Logo company *

Signed on behalf of *

Title *

I have read and understood the Infrachain privacy notice. * Yes

By signing this adherence form I agree with the by-laws of Infrachain Asbl and I acknowledge that the above provided information are accurate. Yes