CORPORATE MEMBERSHIP FORM

1. NAME OF COMPANY:(Required)

2. TYPE OF COMPANY:(Required)

3. YEAR OF FORMATION:(Required)

4. NATURE OF BUSINESS:(Required)

5. SHAREHOLDING:(Required)

6. KEY OFFICERS:(Required)

Column 1

Column 2

Column 3

7. ADDRESS:(Required)

Street Address Address Line 2 City Country

8. TEL/MOBILE NO:

EMAIL:

9. LOCATION:(Required)

10. DO YOU HAVE A MARKETING DEPARTMENT:(Required)

11. BRIEF FUNCTIONS OF MARKETING DEPARTMENT:(Required)

12. IS IT HEADED BY A PROFESSIONAL MARKETER(Required)

13. TRADE REFERENCES OR BANKERS:(Required)

Column 1

Column 2

SIGNATURE:(Required)

Max. file size: 100 MB.

DATE:(Required)

COMPANY STAMP:(Required)

Max. file size: 100 MB.

Phone

This field is for validation purposes and should be left unchanged.

DUES

1. REGISTRATION

GH¢ 50.00

2. ANNUAL FEES

I. PLATINUM – GH¢ 3,000.00

II. GOLD – GH¢ 1,500.00

III. SILVER – GH¢ 1,300.00

IV. MICRO (STARTUPS) – GH¢ 1,000.00