Partnership registration

1.	ORGANISATION
	Organisation name*
	Organisation size*	Start-up (up to 5 years, please indicate the date of establishment of your organisation below)Up to 10 employees11 to 49 employees50 to 250 employeesOver 250 employees
	Organisation date of establishment*
	Address*
	Zip-code*
	City*
	Country*
	Province

	Telephone*
	Email*
	Website*

	Business identification number (e.g. Chamber of commerce, EIN, Kamer van Koophandel)*
	Brief description of the organisation*
	Expectations of the partnership
	Partnership Type*	Community PartnerNetwork Partner
	Community*	Personalised NutritionThe Protein CommunityUpcycling CommunityNetwork partner only
	What do you have to offer to other partners?
2.	CONTACT
	Name contact*
	Job title*
	Telephone*
	Email*
	Mobile*
3.	BILLING ADDRESS (if different from contact person)
	Organisation name
	Contact
	Address
	Zip-code
	City
	Country
	Email
	VAT-Number
	Purchase order (PO) number, if necessary
4.	CONTACT PERSON MARKETING & COMMUNICATION
	Name
	Address
	Mobile phone number
	Email
5.	CONFIRMATION
	By sending this form I agree to the terms and conditions as stated in the privacy statement*.
	Date*
	Your name
	Your job-title


*	Fields marked with a* are required