ERIK Partners
Membership Application Form
Observer 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:
Legal Status:
2. Regional Contact Details:
Name of the Regional Authority and Department responsible for the implementation
of the Regional Programme of Innovative Actions 2000-2006 (if different from the references provided above):
Country:
Address:
Web-site:
Name of Signatory (person in charge of the RPIA implementation):
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:
Regional Programme of Innovative Actions ? Title:
Regional Programme of Innovative Actions - Strategic themes: