ERIK Network Members
Membership Application Form
MEMBERSHIP APPLICATION FORM

The original signed form should also be returned to:
ERIK - Brussels Office c/o
Regione Toscana Brussels Office
Rond Point Schuman, 14
1040 Brussels

1. Membership Details:
Organisation:
Country:
Address of the Organisation:
Web-site address:
Contact Person within the Organisation
Name:
Role:
Telephone:
Fax:
E-mail:
Name:
Role:
Telephone:
Fax:
E-mail:
Legal Status:
2. Regional Contact Details:
Name of the Regional Authority and Department who is Managing
Authority of the Regional Operative Programme (ROP)
Country:
Address:
Web-site:
Name of Signatory
(person in charge of ROP or delegated by Managing Authority):
Title and Position of Signatory:
Contact details of Signatory:
Organisation:
Address:
Telephone:
Fax:
E-mail:
Contact Person within the Regional Authority:
Name:
Role:
Telephone:
Fax:
E-mail:
Priorities of Regional Operative Programme (ROP)
Are you interested in being informed about Capitalisation Project activities?
Yes No
Are you interested in being informed about Fast Track activities?
Yes No