MEMBERSHIP

Application FORM

ORGANIZATION INFORMATION:

Company Name: ________________________________________________
Address: ______________________________________________________
City: ____________________________ State \ Province: ________________ Country:____________
Postal / Zip Code: _________________ Tel: __________________________
Fax: ____________________________ E-mail: _______________________________

PERSONAL INFORMATION:
Primary contact person: _____________________________
Title: ____________________

OPERATOPN ONFORMATION:
Type of business: ______________________________________________
In business since: ________________________
Franchising since: _______________________________
No. of units:
Franchised: __________
Company Owned:___________
Other: _____________________

MEMBERSHIP CATEGORIES ( Please tick one):




DUES PAYMENT ( Please indicate method of payment enclosed):
· Cheque, in US$ made payable to the ADFU
· Credit Card: Mastercard, Visa, and American Express.
· Card No.: _________________________________________ Expiry Date: ____________________
· Cardholder`s Name: _________________________________
· Wire Transfer: contact us for bank details.

Sign _____________________________ Date:__________________________

Please return this form to:
ADFU, P.O. Box#148 / 3, Bolshaya Morskaya Str., Sevastopol 99011, Ukraine.
Tel.: (380 692) 540 - 534. (380 6920 236 - 671.
FAX: (380 692) 550 - 012.
E - mail: arfu@stel.sebastopol.ua