Associate Membership Online Application

Name of Applicant/Company

Head Office Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Telephone

Fax

Website

Company Status

Date of Incorporation (if applicable)

Company Registration Number

VAT Number

Ultimate Holding Company (if applicable)

Name & Initials of Directors or Propiertors pf Applicat/Company followd by letters indicating qualifications held:

Who will represent the applicant at LRWA meetings?

Who wil be nominated as Technical contact?

If their addresses/phone numbers/email are different from Head Office please supply:

Please provide the name of the LRWA Manufacturing Member who is sponsoring your application?

Sponsors Signature / Company Name:

Date

Associate Membership