Large Scale Member Application

Large Scale Membership form

Prefix

Tel

Company Representative (Full Name)

First Last

Fax

Position/Title

Mobile

Company Name

Postal Address

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

Homepage Web Address

Managing Director (If different from above)

Description of Industry, Business or Service

Reason for Joining AZMEC

This will help us to provide members with their required services.

Subscription Payment (US $5,500)

Cheque or Bank Transfer

Associate Employees (Apply to the company as a whole, not just to divisions) Mode of Payment: Please mail cheques to: AZME, P.O Box 51110, Lusaka, ZAMBIA