Declaration of Admission  
Associate Member of the DAISY Consortium

Please type in the information requested below and email to: join@daisy.org


Your organization’s original name:

________________________________________________________________

Organization’s name in English:

________________________________________________________________

Please give a brief description of your organization's activities, in English:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Our company is a (please mark one):

__ for-profit organization        __ non-profit organization 

Address:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Phone:   		__________________________________

Fax:  			__________________________________ 
	
General E-mail: 	__________________________________ 

Website:  		__________________________________ 
	
Last name, first name of the authorized representative: 

			__________________________________ 
	
E-mail: 	__________________________________ 

Last name, first name of second contact: 

			__________________________________ 

E-mail: 	__________________________________ 

As the authorized representative of

	______________________________________________

I hereby declare that I have taken cognisance of the Articles of Association of the DAISY Consortium and accept the Regulations relating to Associate Members of the DAISY Consortium in all respects. In particular I declare that our organization will do nothing that could be detrimental to the work of the DAISY Consortium.
 
 
DAISY Associate Member


Signed: 		__________________________________


(Name, typed) 	__________________________________


Date: 			_________