CORPORATE MEMBERSHIP FORM

1. NAME OF COMPANY:(Required)

2. TYPE OF COMPANY:(Required)

3. DATE 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. ANNUAL FEES

Platinum

Gold

Silver

Micro (Startups)

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

12. BRIEF FUNCTIONS OF MARKETING DEPARTMENT:(Required)

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

14. TRADE REFERENCES OR BANKERS:(Required)

Column 1

Column 2

COMPANY STAMP:(Required)

Max. file size: 64 MB.

DATE:(Required)

Phone

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

DUES

GH¢ 50.00

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