LONG TERM CORPORATE MEMBERSHIP ON-LINE APPLICATION

I hereby apply for Long Term Corporate Membership (10 Years) to the India Chapter of IAA.

• Long Term Corporate Membership Fee (10 Years): Rs 80,000 + GST 18% = Rs 94,400/-

* Indicates mandatory fields.

Name of Corporate Entity /Organisation: * Nature of Business: * Name of Nominee: * No. of years with Organisation: Position: * Business Address: * Tel: * Mobile: * Fax: Email: * Website: Education:
I agree to be governed by the rules and regulations of the India Chapter of the International Advertising Association.
Note: The application is subject to approval of the IAA Managing Committee.