ICMA Membership Application Form 1 SECTION ONE2 SECTION 2 We herewith apply for*First year Standard membershipOpen to companies operating in a single country or territory(Only available to companies who have not been ICMA members during the 18 months directly preceding their application.)12 month fee for the first year of membership - € 1195First year Group membershipOpen to companies with operations in more than one country or territory.(Only available to companies who have not been ICMA members during the 18 months directly preceding their application.)12 month fee for the first year of membership - € 2495Name of CompanyAddress Street Address Address Line 2 / State / Province / Region City ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe PhoneValue Added Tax (VAT) numberFor EU countries onlyParent Company (if applicable)Website URL(s)CEO/MDEmail address Number of employees (Full-time)Number of employees (Part-time)Countries operated inAnnual turnover (€ equivalent)Number and business model of classified productsFill in as many as applyMobile sitesSocial sitesNiche online sitesFree ads papersPaid adsNiche papersOnline sitesOthersContact details of other key employeesCONTACT DETAILS OF OTHER KEY EMPLOYEES THAT YOU WISH TO BE ADDED TO THE ICMA DATABASE (USED FOR MAILING THE NEWSLETTER, CONFERENCE PROGRAMMES AND INFORMATION UPDATES; DATA IS NEVER MADE AVAILABLE TO THIRD PARTIES). N.B. APPLICANTS FOR GROUP MEMBERSHIP ARE REQUESTED TO PROVIDE CONTACT DETAILS FOR AT LEAST ONE PERSON FOR EACH COUNTRY OR TERRITORYWould you like to add another key employee?YesNoKey employee 1Name First Last Job titleAddressPhoneEmail Would you like to add another key employee?YesNoKey employee 2Name First Last Job titleAddressPhoneEmail Would you like to add another key employee?YesNoKey employee 3Name First Last Job titleAddressPhoneEmail Would you like to add another key employee?YesNoOther key employeesFill in Name, Job Title, Address, Phone and Email per key employee ICMA Rules & Regulations1. Ensure that our publishing company is in line with ICMA Membership criteria. 2. Accept any sanctions enforced by the Board of Directors, according to the following stages: I. written formal warning II. pecuniary fine determined by the Board of Directors III. suspension IV expulsion 3. Pay all invoices from ICMA in due time, assuming that they are in accordance with decisions made by the Board of Directors 4. All memberships are automatically renewed annually and you must give ICMA 1 month written notice prior to the renewal date should you wish to terminate your membership. 5. Send a copy of relevant papers or website access details to ICMA Head Office with our application. 6. Accept all other rules and regulations which form the Articles and Bylaws of ICMA, or which are agreed upon at any Conferences, and any modifications to them, as long as they are made in accordance with the ICMA Articles and Bylaws, and which may be communicated to us through the Newsletter, website or by any other means.Name of CompanyName of SignatoryWho do we contact with regard to this application?Name First Last Email I declare that all information stated is true. We agree to all ICMA Statutes and Regulations, if we become a member. We understand that we may be obliged to present our application to the ICMA Board of Directors and Membership. I agree Captcha This iframe contains the logic required to handle Ajax powered Gravity Forms.