Application Form Institutional Membership

Velden met een * zijn verplicht.

Membership categorycategory *

Contact dataName institution *
Department / attn. to
Street *
Number *
Number suffix
Postal, areal code *
City *
Country
Telephone number
Contact email address (used for communication) *
Email 2 (i.e. work or private)
Preferred language of communication *

Contact personSalutation *
First name (informal) *
Initials
Infix
Last name

Mail addressPost office box
Number
Postal, areal code
City
Country

Banking dataIBAN (IBAN bankaccount)
BIC / SWIFT
Name account holder
Attn to (i.e. financial dept)

OtherNon-museums are required to upload a brief motivation in which they elaborate on the added value of membership for both ICOM and applicant.

Check MarksI adhere to ICOM’s Ethical Code *
We accept automatic withdrawal of our membership fee by ICOM
We agree to processing and usage of our data in accordance with GPRS rules *